Perioperative Complications and Associated Factors Following Transurethral Resection of the Prostate Among Patients at Benjamin Mkapa Hospital, Tanzania

Perioperative Complications and Associated Factors Following Transurethral Resection of the Prostate Among Patients at Benjamin Mkapa Hospital, Tanzania | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Perioperative Complications and Associated Factors Following Transurethral Resection of the Prostate Among Patients at Benjamin Mkapa Hospital, Tanzania Gerald Phares Mwing'a, Emmanuel Tairo, Hindu Ibrahim Hussein, and 13 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8231557/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 14 You are reading this latest preprint version Abstract Introduction: Transurethral resection of the prostate (TURP) remains the gold standard surgical treatment for moderate to severe lower urinary tract symptoms (LUTS) secondary to benign prostate enlargement (BPE). Despite its effectiveness, TURP is associated with several perioperative complications which varies across settings. In Tanzania, evidence on complication rates and associated factors remains limited. This study assessed the prevalence and determinants of perioperative complications following TURP at Benjamin Mkapa Hospital between 2021 and 2023. Methods An analytical cross-sectional study was conducted using routinely collected data from the Medipro-5 and Mapping Tag ERX systems at BMH, included men aged ≥ 40 years diagnosed with BPH who underwent TURP and had at least one year of postoperative follow-up. Patients with prior prostate/urethral surgery, neurogenic bladder, or incidental prostate cancer were excluded. Descriptive statistics summarized patient characteristics. Modified Poisson regression with robust error variance estimated crude and adjusted prevalence ratios (aPRs) with 95% confidence intervals (CIs) for factors associated with complications, and p < 0.05 being considered statistically significance. Results Among 705 eligible men (mean age 69 ± 8.9 years), 18.7% experienced at least one complication. Ejaculatory dysfunction (10.4%) and urethral stricture (4.5%) were the most frequent complications. Based on the Clavien-Dindo classification: 10.4% were grade I, 2.3% grade II, 7.6% grade III, and 0.6% grade IV. In adjusted analysis, increasing age (aPR = 1.11; 95% CI: 1.11–1.13), catheterization > 3 days (aPR = 3.10; 95% CI: 1.58–6.06), hypertension (aPR = 1.30; 95% CI: 1.09–1.24), and diabetes (aPR = 1.85; 95% CI: 1.22–2.80) were significantly associated with higher prevalence of complications. However, TURP mode showed no significant association (p = 0.575) Conclusion Nearly one-fifth of men undergoing TURP at BMH developed postoperative complications, mostly mild but clinically important. Older age, prolonged catheterization, hypertension, and diabetes increased complication risk. Strengthening perioperative optimization may improve outcomes TURP complications benign prostate enlargement Tanzania urology Figures Figure 1 Background Transurethral resection of the prostate (TURP) is among the widely used endoscopic approach for surgical treatment of moderate to severe lower urinary tract symptoms (LUTS) resulting from benign prostate enlargement (BPE), and has been considered a gold standard treatment for this condition for many decades [ 1 ]. It involves resection of tissues from the transition zones of the gland by means of an electrified wire loop to achieve volume and prostate specific antigen (PSA) reduction. This procedure can be carried out in two modes; Monopolar (M-TURP) or bipolar TURP (B-TURP). In monopolar TURP the energy travels through the body of a patient to the pad, whereas bipolar systems the energy is confined in the resectoscope. Non-ionic fluids such as glycine, dextrose and mannitol are used for continuous irrigation in M-TURP while normal saline is used in B-TURP [ 2 ]. Both the European Association of Urology (EAU) and American Urological Association (AUA) recommend TURP for prostates 30–80 mL and for patients who fail medical therapy or present with complications such as recurrent urinary retention, bladder stones, recurrent urinary tract infections, or renal impairment [ 3 , 4 ] Globally, TURP utilization has been declining with increased uptake of minimally invasive techniques such as holmium laser enucleation of the prostate (HoLEP) and photo selective vaporization of the prostate (PVP), owing to their improved perioperative safety profiles [ 5 , 6 ]. In African settings, including Tanzania, TURP remains the predominant option because of limited access to HoLEP technology, financial constraints, and training opportunities [ 7 , 8 ]. Despite its effectiveness, TURP is associated with a range of perioperative complications [ 9 ]. International estimates show overall complication rates of 10–20%, intraoperative risks of about 3%, and mortality under 0.5% [ 9 , 10 ]. Reported complications include haemorrhage requiring transfusion, clot retention, TUR syndrome, urinary tract infection, prolonged catheterization, urethral stricture, bladder neck contracture, redo surgery, urinary incontinence, and ejaculatory dysfunction [ 11 , 12 ]. Various studies have documented factors associated with complications after TURP. First, prolonged surgical duration correlates with higher risk of postoperative bleeding, transfusion, thromboembolic events, infection, and reoperation (e.g., when operative time exceeds 120 minutes) [ 13 ]. Second, larger prostate size and greater vascularity increase the likelihood of excessive bleeding and incomplete resection [ 14 ]. Third, preoperative administration of 5α-reductase inhibitors (such as finasteride) for several weeks before TURP has been shown to reduce perioperative blood loss by decreasing micro vessel density in the prostate [ 15 ]. Finally, other reported risk determinants include comorbidity burden, preoperative urinary infections, and inadequate preoperative optimization, which collectively influence overall outcome following TURP. In Tanzania, efforts to reduce TURP-related morbidity have focused on adopting bipolar systems, strengthening perioperative monitoring, optimizing haemostasis, and improving surgical training [ 8 , 16 , 17 ]. However, evidence on the burden and determinants of TURP complications in the central zone of Tanzania remains limited. Therefore, this study assessed perioperative complications and associated factors among adult men undergoing TURP at Benjamin Mkapa Hospital (BMH) between 2021 and 2023. Methods Study design and setting This was analytical cross-sectional design conducted at Benjamin Mkapa Hospital (BMH) in Dodoma, Tanzania. The hospital is located within the University of Dodoma compounds about 16km from the city center, it serves as a zonal hospital in the central zone of Tanzania. The BMH receives majority of patients from Dodoma, Singida, Tabora, Manyara, Iringa and Morogoro regions. The hospital has a bed capacity of 400 beds with bed occupancy of approximately 200 to 250 patients. Additionally, it is used as a teaching hospital for the University of Dodoma (UDOM). The BMH was established in 2015 with the aim of offering specialized and super specialized services including urologic surgery. The urology department has a bed capacity of 25 beds, 7 urologists and 15 nurses. On average, 20 patients are admitted each month for TURP. The department currently uses a single operating theatre room with a single operating tower. Study population and eligibility All adult males aged 40 years and above, who underwent TURP at BMH after being diagnosed with Benign prostate hyperplasia (BPH) between January 2021 and December 2023. The study included patients who had attended clinic for at least one-year post TURP. However, those who had prior history of TURP or any prostate or urethral procedure such as open prostatectomy, Transurethral incision of the prostate (TUIP), Direct visual urethrotomy (DVU), or urethroplasty at other facilities were excluded in the analysis. Likewise, those who had a concurrent condition causing LUTS such as neurogenic bladder, and patients who had incidental prostate cancer were also excluded. Sample size and sampling procedure A total of 1,029 men aged ≥ 40 years underwent TURP between January 2021 and December 2023 at Benjamin Mkapa Hospital (BMH). Among them, 705 met eligibility criteria, and included in the analysis in the study. Data extraction and collection procedure The dataset for this study was obtained from the hospital patient record system such as Medipro-5 and Mapping tag ERX hospital system in which the patients’ records are stored. All the required information was collected in the system by the trained research assistants who used a list of constructed structured questionnaire. A structured questionnaire was developed specifically for this study in data collection. An English-language version of the questionnaire has been provided as Supplementary File 1. After a thorough review of the dataset structure, variable definitions, and coding framework with additional recoding and data cleaning were performed to refine variables and ensure they aligned with the study objectives. These steps were taken to improve the dataset’s suitability for statistical analysis. The research team evaluated the collected information by observing the ward rounds notes, follow-up visits notes, laboratory results, imaging results, cystoscopy findings, and urine culture reports. Further, the IPSS recorded pre-operatively and post-operatively 1 year after surgery, were also collected. Other data including mode of TURP performed, preoperative prostate volume, duration of hospital stay, duration of catheterization, duration of medical treatment before TURP, occurrence of TUR syndrome, excessive bleeding, UTI, Urethral stricture, Bladder neck contracture, urinary incontinence, and retrograde ejaculation after TURP were collected. Variable measurements Dependent variables The dependent/outcome variable of this study was the “Complications following TURP” procedure. This variable was generated a list of the available outcomes of TURP such as TUR-syndrome; Reported as serum sodium levels of less than 125Meq/L after TURP accompanied with documented symptoms of dilutional hyponatremia in the progress notes, UTI; A positive urine culture of mid-urine-catch within 2 weeks of TURP with least one UTI-causing organism isolated, Excessive hemorrhage; Laboratory results showing HB less than 7g/dl and/or Hematocrit less than 21 within 7 days of TURP or at least 1 blood transfusion administered during perioperative period, Urethral stricture; Urethral lumen less than 16Fr accompanied with LUTS, Excessive hemorrhage; Laboratory results showing HB less than 7g/dl and/or Hematocrit less than 21 within 7 days of TURP or at least 1 blood transfusion administered during perioperative period, Bladder neck contracture; Occurrence of bladder outlet obstruction (BOO) caused by bladder neck stenosis as revealed by cystoscopy findings, Urine incontinence; Occurrence of involuntary loss of urine experienced during the bladder storage phase which occurred at least 6 months post TURP, and Ejaculatory dysfunction: absence or abnormal ejaculation. The outcome variable “complications” was therefore coded as “1” to those reported with at least one complication and “0” otherwise. Independent variables The independent variables in this study included participant’s age in years, occupation, and place of residence, mode of TURP (bipolar/monopolar), duration of hospital stays in days, duration of catheterization in days, preoperative prostate volume in cubic centimeters, preoperative IPSS, and comorbidities (hypertension, and diabetes). Data analysis plan We extracted relevant variables related to TURP surgery performed in 2021 to 2023 from the hospital records, to address the study’s objectives. All the analyses were performed using Stata version 17 (Stata Corp, College Station, TX). Descriptive Analysis were summarized using mean and standard deviations for the continuous variables, and percentages for the categorical variables. The proportions of complications following TURP procedure by participant’s characteristics was determined to describe its distributions across their levels. The Bivariate and Multivariable modified Poisson regression model for analysis of factors associated with complications among patients who underwent TURP at BMH, was fitted to determine the independent factor contributing to complications following TURP procedure. We fitted a modified Poisson regression models to estimate for the adjusted prevalence ratios (aPRs) with 95% confidence intervals (CIs), with variables of p < 0.2 in bivariate analysis be considered in the multivariable analysis, and the statistical significance was set at p < 0.05. Ethical consideration The anonymized data used in this study were obtained from the Medipro-5 and Mapping tag ERX hospital system with proper authorization. The extraction process was designed to safeguard privacy and confidentiality to avoid access to personal identifiable information, such as file numbers, in accordance to ethical standards. The ethical approval of using the data was secured from the Benjamin Mkapa Hospital (BMH). RESULTS Characteristics of study participants A total of 705 participants were recruited for this study. The mean age was 69 years (SD = ± 8.9), with the majority 602 (85.4%), aged 60 years and above. More than two third participants were peasants, accounting for 500 (70.9%), and 539 (76.5%) had NHIF type of insurance. Regarding the surgical procedure, 461 (65.4%) underwent the bipolar mode of operation. Preoperatively, most participants were hospitalized for five days or less 632 (89.7%) and had catheterization for no more than three days 686 (97.3%). Additionally, 532 (75.5%) had a preoperative prostate size of less than 80 cm³, with the mean preoperative IPSS (SD) of 27.2 (SD = ± 3.3). Concerning comorbidities, 261 (37.1%) had hypertension, while a smaller proportion of 50 (7.1%), had diabetes ( Table 1 ). Table 1 Characteristics of the study participants (N = 705) Variable Frequency n (%) Mean age (years) 69 ± 8.9 Age in years 40–59 103 (14.6) ≥ 60 602 (85.4) Occupation Civil servant 21 (3.0) Peasant 500 (70.9) Entrepreneur 32 (4.5) Retired 152 (21.6) Insurance type NHIF 539 (76.5) JWTZ 20 (2.8) Self-supported 146 (20.7) Residence Dodoma 456 (64.7) Regions bordering Dodoma 155 (22.0) Other TZ regions 94 (13.3) TURP mode Bipolar 461 (65.4) Monopolar 244 (34.6) Hospitalization time (days) Standard (≤ 5 days) 632 (89.7) Prolonged (> 5 days) 73 (10.4) Catheterization time (days) Standard (≤ 3 days) 686 (97.3) Prolonged (> 3 days) 19 (2.7) Finasteride use duration in months (n = 703) Not recommended (< 6 months) 478 (68.0) Recommended (≥ 6 months) 225 (32.0) Pre-op prostate volume ( cm 3 ) ≥ 80 173 (24.5) < 80 532 (75.5) Hypertension (n = 703) No 442 (62.9) Yes 261 (37.1) Diabetes (n = 704) No 654 (92.9) Yes 50 (7.1) Preoperative IPSS 27.2 ± 3.3 Prostate Volume (cm 3 ): median (IQR) 64 (IQR = 53–80) Hospitalization time (days): median (IQR) 5 (IQR = 5–5) Catheterization time (days): median (IQR) 2(IQR = 2–2) Finasteride use duration (months) 6 (IQR = 3–8) IQR: Interquartile range Proportion of participants with various kind of complications following TURP Out of the 705 men who underwent TURP surgery at BMH, 132 (18.7%) had at least one complication following TURP procedure. Various kinds of complications, with ejaculatory dysfunction contributing highest proportion of 10.4%, followed by urethral stricture with 4.5%. However, among all the participants 28% reported that they were not sexually active. Other complications, include surgical redo, urinary tract infection, clot retention, TUR syndrome, blood transfusion and urine incontinence ( Fig. 1 ). These complications were classified using the Clavien-Dindo system, a standardized method for grading the severity of surgical complications, including those after TURP [ 18 ]. Among the 705 patients, 10.4% were grade I (e.g., ejaculation dysfunction) requiring no intervention, 2.3% were grade II (e.g., UTI, blood transfusion, urine incontinence) requiring medical treatment, 7.6% were grade III (e.g., urethral stricture, bladder neck contracture, clot retention) requiring surgery, and 0.6% were grade IV (TUR syndrome), representing life-threatening complications ( Fig. 1 ). Proportion of complications by participant characteristics Overall, 18.7% of participants experienced at least one complication following the TURP procedure. A significantly higher proportion of complications occurred among men aged ≥ 60 years (68.2%) compared to those aged 40–59 years (31.8%) (p < 0.001). Peasant workers also exhibited a higher proportion of complications (62.1%, p < 0.001) relative to participants in other occupations. Although complications were more frequently observed among men operated using the bipolar technique (64.4% vs. 35.6%), this difference was not statistically significant (p = 0.792). Both hospitalization duration and catheterization time showed statistically significant associations with complications (p < 0.001 for each). Regarding the comorbidities, hypertensive patients had a significantly lower proportion of complications compared to non-hypertensive men (53.0% vs. 47.0%). Diabetes status was also significantly associated with postoperative complications, with 15.2% of complications occurring in men with diabetes and 84.8% in those without diabetes (p < 0.001) ( Table 2 ). Table 2 Proportion of complications by participant characteristics (N = 705) Variable Total (N) With Complication p-value n (%) 705 18.7 Age group < 0.001 40–59 103 42 (31.8) ≥ 60 602 90 (68.2) Occupation < 0.001 Civil servant 21 11 (8.3) Peasant 500 82 (62.1) Entrepreneur 32 7 (5.3) Retired 152 32 (24.2) Type of insurance 0.014 NHIF 539 104 (78.8) JWTZ 20 8 (6.1) Self-supported 146 20 (15.2) Residence 0.219 Dodoma 456 77 (58.3) Regions bordering Dodoma 155 33 (25.0) Other TZ regions 94 22 (16.7) TURP mode 0.792 Bipolar 461 85 (64.4) Monopolar 244 47 (35.6) Hospitalization time 5 days) 73 26 (19.7) Catheterization time 3 days) 19 13 (9.9) Finasteride use duration 0.162 Not recommended (< 6 months) 478 83 (62.9) Recommended (≥ 6 months) 225 49 (37.1) Prostate size (cm 3 ) 0.138 ≥ 80 173 39 (29.6) < 80 532 93 (70.5) Hypertension 0.009 No 442 70 (53.0) Yes 261 62 (47.0) Diabetes < 0.001 No 654 112 (84.8) Yes 50 20 (15.2) Adjusted prevalence ratios (aPR) for factors associated with complications following TURP among patients at BMH In the adjusted analysis, increasing age (aPR = 1.11, 95% CI: 1.11–1.13, p 3 days) (aPR = 3.10, 95% CI: 1.58–6.06, p < 0.001), hypertension (aPR = 1.30, 95% CI: 1.09–1.24, p = 0.008), and diabetes (aPR = 1.85, 95% CI: 1.22–2.80, p < 0.001) were significantly associated with a higher prevalence of post-TURP complications. Men who underwent the monopolar procedure had a lower prevalence of complications compared with those who received the bipolar technique (aPR = 0.91, 95% CI: 0.67–1.25), although this association was not statistically significant (p = 0.575) ( Table 3 ). Table 3 Bivariate and Multivariable analysis of factors associated with complications following TURP among men with benign prostatic hyperplasia at BMH (N = 705) Variable cPR (95% CI) p-value aPR (95% CI) p-value Age 1.13 (1.10–1.14) < 0.001 1.1 (1.11–1.13) < 0.001 Occupation Civil servant ref ref Peasant 0.31 (0.20–0.49) < 0.001 0.99 (0.54–1.83) 0.983 Entrepreneur 0.42 (0.19–0.90) 0.027 0.78 (0.35–1.72) 0.532 Retired 0.40 (0.24–0.67) < 0.001 1.14 (0.60–2.17) 0.693 Residence Dodoma ref Bordering Regions 1.26 (0.88–1.82) 0.213 Other TZ Regions 1.39 (0.91–2.11) 0.127 TURP Mode Bipolar ref ref Monopolar 1.04 (0.76–1.44) 0.789 0.91 (0.67–1.25) 0.575 Duration of Hospital Stay ≤ 5 days ref ref > 5 days 2.12 (1.49–3.03) 3 days 3.94 (2.79–5.58) < 0.001 3.10 (1.58–6.06) < 0.001 Duration of finasteride use < 6 months ref ref ≥ 6 months 1.25 (0.91–1.72) 0.16 1.23 (0.91–1.66) 0.174 Prostate Size (cm 3 ) ≥ 80 ref ref < 80 0.78 (0.56–1.08) 0.134 0.81 (0.58–1.13) 0.209 Preoperative IPSS 1.05 (1.00–1.11) 0.034 1.02 (0.97–1.07) 0.402 Hypertension No ref ref Yes 1.50 (1.10–2.04) 0.009 1.30 (1.09–1.24) 0.008 Diabetes No ref ref Yes 2.34 (1.60–3.41) < 0.001 1.85 (1.22–2.80) < 0.001 cPR: Crude prevalence ratio, aPR: adjusted prevalence ratio, CI: confidence interval Discussion This study assessed postoperative complications and associated factors among 705 men undergoing transurethral resection of the prostate (TURP) at Benjamin Mkapa Hospital (BMH). Nearly one-fifth of patients (18.7%) experienced at least one complication following TURP, a prevalence that aligns with international estimates of 10–20% reported in large multicentre analyses [ 19 ] and summarized in the European Association of Urology (EAU) guidelines [ 20 ]. In this study, ejaculatory dysfunction was the most common complication, occurring in 10.4% of patients, which is noticeably lower than the 30–70% reported in Western populations. For instance, a systematic review of TURP trials reported retrograde ejaculation in approximately 46% of patients [ 21 ] while other reviews and cohort studies have documented rates of 47–65% after TURP [ 22 , 23 ]. This comparatively lower rate may partly reflect reduced sexual activity in older Tanzanian men, cultural reluctance to report sexual issues, and poor routine postoperative sexual function assessment issues echoed in sub-Saharan urological studies where underreporting of sexual complications is common. We found that, Urethral stricture (4.5%) was among the leading severe complications, consistent with internationally reported post‑TURP stricture rates ranging from 2–10% [ 21 ], with bipolar TURP reported a rate of 4.3% [ 24 ], and 3.9% rate in monopolar procedure [ 25 ]. In Tanzania, several possible contextual factors, including delayed health seeking behaviour, recurrent UTIs before surgery, and limited access to specialized postoperative follow-up may exacerbate stricture risk compared to high-resource settings [ 26 ]. Local studies have similarly emphasized late presentation and high baseline comorbidity burden among BPH patients, contributing to postoperative morbidity [ 8 ]. We found that advancing age was strongly associate with postoperative complications. This finding consistent a recent study of elderly men (≥ 80 years) undergoing TURP reported a 30-day complication rate of 9.5% which indicate a higher perioperative risk in older patients [ 27 ]. Additionally, another large cohort study found that early urethral stricture occurred in 3.9% of TURP patients, and identified higher comorbidity burden (which increases with age) as an independent risk factor for stricture formation [ 28 ]. These findings support the increased vulnerability of older men to TURP complications, underscoring the need for cautious preoperative assessment and optimization in older patients in our setting. Prolonged catheterization (> 3 days) was associated with higher complication rates in our study, which could reflect increased risk of catheter associated infection, mucosal irritation, or catheter-related trauma. While some studies outside the TURP setting report that longer indwelling catheter time increases urinary tract infections and other morbidity, and one small bipolar-TURP series noted an association between extended catheter dwell time and stricture formation [ 29 ], large TURP-specific series often identify other risk factors, including prolonged operative time and comorbidity burden rather than catheter duration itself [ 28 ]. With this limited and inconsistent evidence, in resource limited settings like Tanzania, where postoperative monitoring and catheter care may be suboptimal, it is plausible that prolonged catheterization adds risk, though causality cannot be firmly established. In this study, we found that hypertension and diabetes was significant determinants of postoperative complications. This result is consistent with wide-ranging surgical evidence indicating that metabolic and vascular diseases impair wound healing and increase the risk of postoperative morbidity. For example, a recent meta-analysis found that diabetes mellitus raised the risk of any postoperative complication, including infections, reoperations, and wound healing disorders [ 30 ]. Similarly, evidence show that poor glycaemic control has been strongly associated with delayed wound healing, surgical site infections, dehiscence, and extended hospital stays in multiple surgical cohorts [ 31 ]. Therefore, in the settings like Tanzania where chronic disease control is often suboptimal, comorbid hypertension or diabetes may significantly elevate the risk of complications after TURP. Finally, we found that mode of TURP (monopolar versus bipolar) was not significantly associated with complications. This is consistent with randomized trials and meta-analyses showing broadly comparable overall safety and functional outcomes between monopolar and bipolar TURP, despite some advantages of bipolar systems in reducing TUR syndrome and blood loss [ 32 – 34 ]. For resource-limited settings such as Tanzania, potential benefits of bipolar TURP may be lessened by variability in experienced surgeon, with equipments, and patient comorbidity profiles. Conclusion In this study of men undergoing TURP at Benjamin Mkapa Hospital, nearly 20% of them experienced postoperative complications, predominantly mild to moderate. Ejaculatory dysfunction and urethral stricture were the most frequent. Advanced age, prolonged catheterization, hypertension, and diabetes were significant independent predictors, highlighting the need for targeted preoperative assessment and optimization to reduce complication risk and improve surgical outcomes. Recommendations To reduce TURP complications in Tanzania, preoperative optimization of comorbidities such as hypertension and diabetes is essential, especially in older patients. Postoperative care should focus on minimizing catheterization duration and ensuring structured follow-up for early detection of complications. Strengthening surgical capacity through training, and proper perioperative monitoring is critical. Additionally, patient education on catheter care, warning signs, and expected outcomes, along with maintaining a TURP outcomes registry, can improve surgical safety and quality of care. Future research should focus on prospective, multicenter studies to evaluate intraoperative factors, long-term outcomes, and strategies to reduce TURP complications in low-resource settings. Strengths and Limitations This study has several strengths, including the use of large sample size of 705 patients and the use of routinely collected hospital data, providing real-world insights. Analysis of independent variables offers practical guidance for perioperative care, and the findings address a knowledge gap in Tanzania and similar settings. However, the retrospective single-center design may limit generalizability, and some clinical variables, such as intraoperative blood loss, surgeon experience, and detailed prostate characteristics, were not captured. Mild or late complications may have been underreported, and unmeasured confounders like lifestyle and socioeconomic factors could influence outcomes. Declarations Funding statement This study did not receive funding. Competing interests No competing interest between authors. Ethical approval and consent to participate Ethical approval for this study was obtained from the Institutional Research Review Ethics Committee (IRREC) of the University of Dodoma. Permission to access and use secondary data was granted by the Office of the Vice Chancellor, University of Dodoma, and the Executive Director of Benjamin Mkapa Hospital (BMH). As the study involved de-identified secondary data with no direct contact with participants, the requirement for informed consent was waived. The study adhered to the ethical principles of the Declaration of Helsinki. Participant confidentiality was ensured through the use of unique identification codes, and all data were securely stored and accessible only to authorized personnel. Availability of data and materials The dataset, materials, and codes used to produce this manuscript is available upon request to the corresponding author and Benjamin Mkapa Hospital administration. Author contributions Conceptualization, GPM, ET, HIH, EM, RR, OS, VK, and JE; methodology, GPM, SSK, SAK, and AML; software, GPM, AML and SSK; formal analysis, GPM, and SSK; data curation, GPM, AML, HIH, and SAK; writing - original draft, GMP, ET, and HIH; writing - review and editing, GPM, ET, HIH, BE, AML, SSK, EM, SAK, SM, OS, VK, RR, JE, MK, AC, and AM; visualization, GMP; supervision, BE, AML, MC, AC, and AM; Resources, AM. All authors have read and approved the final manuscript. 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Electrolyte imbalance monitoring following Transurethral Resection of the Prostate: A Descriptive Case Series Study. Int j endorsing health sci res. 2024;12(3):148–53. Dindo D, Demartines N, Clavien Palain. Classif Surg Complications. 2004;240(2):205–13. Kashefi C, Messer K, Barden R, Sexton C, Parsons JK. Incidence and Prevention of Iatrogenic Urethral Injuries. The Journal of Urology [Internet]. 2008 June [cited 2025 Nov 28]; Available from: https://www.auajournals.org/doi/ 10.1016/j.juro.2008.01.108 EAU. EAU Guidelines - Uroweb [Internet]. 2025 [cited 2025 Nov 28]. Available from: https://uroweb.org/guidelines Porto JG, Bhatia AM, Bhat A, Suarez Arbelaez MC, Blachman-Braun R, Shah K, et al. Evaluating transurethral resection of the prostate over twenty years: a systematic review and meta-analysis of randomized clinical trials. World J Urol. 2024;42(1):639. Pavone C, Abbadessa D, Scaduto G, Caruana G, Scalici Gesolfo C, Fontana D, et al. 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Surgical Outcomes for Elderly Patients Undergoing Transurethral Resection of the Prostate for Chronic Urinary Retention and Proposal of a Management Algorithm. J Endourol. 2023;37(5):581–6. Gür A, Sönmez G, Demirtaş T, Tombul ŞT, Halitgil K, Demirtaş A. Risk Factors for Early Urethral Stricture After Mono-Polar Transurethral Prostate Resection: A Single-Center Experience. Cureus [Internet]. 2021 Nov 17 [cited 2025 Nov 28]; Available from: https://www.cureus.com/articles/77684-risk-factors-for-early-urethral-stricture-after-mono-polar-transurethral-prostate-resection-a-single-center-experience Wald HL, Ma A, Bratzler DW, Kramer AM. Indwelling Urinary Catheter Use in the Postoperative Period: Analysis of the National Surgical Infection Prevention Project Data. Arch Surg 2008 June 16;143(6):551–7. Zhang X, Hou A, Cao J, Liu Y, Lou J, Li H, et al. Association of Diabetes Mellitus With Postoperative Complications and Mortality After Non-Cardiac Surgery: A Meta-Analysis and Systematic Review. Front Endocrinol (Lausanne). 2022;13:841256. Fadhil T, Batool A, Khan H, Farooq MS. Wound Healing in Diabetic Patients Undergoing Abdominal Surgery: A Retrospective Study. Cureus 17(8):e90132. Sinha MM, University Hospital Southampton NHS, Foundation Trust, Southampton UK, Pietropaolo A, University Hospital Southampton NHS, Foundation Trust, Southampton UK, Hameed BMZ et al. Department of Urology, Father Muller Medical College, Karnataka, India,. Outcomes of bipolar TURP compared to monopolar TURP: A comprehensive literature review. Turkish Journal of Urology. 2022;48(1):1–10. Mamoulakis C, Ubbink DT, de la Rosette JJMCH. Bipolar versus Monopolar Transurethral Resection of the Prostate: A Systematic Review and Meta-analysis of Randomized Controlled Trials. Eur Urol. 2009;56(5):798–809. Hueber PA, Al-Asker A, Zorn KC. Monopolar vs. bipolar TURP: assessing their clinical advantages. cuaj. 2011;5(6):390–1. Additional Declarations No competing interests reported. Supplementary Files Supplementaryfile1Questionnaire.pdf Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Revision requested 12 Feb, 2026 Reviewers agreed at journal 08 Feb, 2026 Reviews received at journal 08 Feb, 2026 Reviewers agreed at journal 05 Feb, 2026 Reviewers agreed at journal 03 Feb, 2026 Reviews received at journal 24 Jan, 2026 Reviewers agreed at journal 18 Jan, 2026 Reviews received at journal 17 Jan, 2026 Reviewers agreed at journal 08 Jan, 2026 Reviewers invited by journal 08 Jan, 2026 Editor assigned by journal 05 Jan, 2026 Editor invited by journal 12 Dec, 2025 Submission checks completed at journal 11 Dec, 2025 First submitted to journal 11 Dec, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8231557","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":572570030,"identity":"50ceda93-2f7a-4a79-813b-69832c5c3e22","order_by":0,"name":"Gerald Phares 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09:27:05","extension":"html","order_by":7,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":134988,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-8231557/v1/4dd64c71d195d6d68bbdf596.html"},{"id":100367061,"identity":"b3c4b34d-181e-4a4c-ab6a-9b52d476221e","added_by":"auto","created_at":"2026-01-16 07:56:45","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":23161,"visible":true,"origin":"","legend":"\u003cp\u003eProportion of participants with various complications following TURP\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-8231557/v1/f2d76ef88d09bab8d22b7d37.png"},{"id":100382102,"identity":"81401367-7952-46c5-8874-cafee9232b2d","added_by":"auto","created_at":"2026-01-16 10:40:57","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1505204,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8231557/v1/cb6293d7-8a7e-4c17-bccd-8a7e25ad8709.pdf"},{"id":100127142,"identity":"ebf918b1-7058-4b0c-8bda-cf1c064b3fd6","added_by":"auto","created_at":"2026-01-13 09:27:05","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":91364,"visible":true,"origin":"","legend":"","description":"","filename":"Supplementaryfile1Questionnaire.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8231557/v1/0d53e58499e832f273c4557f.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Perioperative Complications and Associated Factors Following Transurethral Resection of the Prostate Among Patients at Benjamin Mkapa Hospital, Tanzania","fulltext":[{"header":"Background","content":"\u003cp\u003eTransurethral resection of the prostate (TURP) is among the widely used endoscopic approach for surgical treatment of moderate to severe lower urinary tract symptoms (LUTS) resulting from benign prostate enlargement (BPE), and has been considered a gold standard treatment for this condition for many decades [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. It involves resection of tissues from the transition zones of the gland by means of an electrified wire loop to achieve volume and prostate specific antigen (PSA) reduction. This procedure can be carried out in two modes; Monopolar (M-TURP) or bipolar TURP (B-TURP). In monopolar TURP the energy travels through the body of a patient to the pad, whereas bipolar systems the energy is confined in the resectoscope. Non-ionic fluids such as glycine, dextrose and mannitol are used for continuous irrigation in M-TURP while normal saline is used in B-TURP [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Both the European Association of Urology (EAU) and American Urological Association (AUA) recommend TURP for prostates 30\u0026ndash;80 mL and for patients who fail medical therapy or present with complications such as recurrent urinary retention, bladder stones, recurrent urinary tract infections, or renal impairment [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eGlobally, TURP utilization has been declining with increased uptake of minimally invasive techniques such as holmium laser enucleation of the prostate (HoLEP) and photo selective vaporization of the prostate (PVP), owing to their improved perioperative safety profiles [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn African settings, including Tanzania, TURP remains the predominant option because of limited access to HoLEP technology, financial constraints, and training opportunities [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Despite its effectiveness, TURP is associated with a range of perioperative complications [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. International estimates show overall complication rates of 10\u0026ndash;20%, intraoperative risks of about 3%, and mortality under 0.5% [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Reported complications include haemorrhage requiring transfusion, clot retention, TUR syndrome, urinary tract infection, prolonged catheterization, urethral stricture, bladder neck contracture, redo surgery, urinary incontinence, and ejaculatory dysfunction [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eVarious studies have documented factors associated with complications after TURP. First, prolonged surgical duration correlates with higher risk of postoperative bleeding, transfusion, thromboembolic events, infection, and reoperation (e.g., when operative time exceeds 120 minutes) [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Second, larger prostate size and greater vascularity increase the likelihood of excessive bleeding and incomplete resection [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Third, preoperative administration of 5α-reductase inhibitors (such as finasteride) for several weeks before TURP has been shown to reduce perioperative blood loss by decreasing micro vessel density in the prostate [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Finally, other reported risk determinants include comorbidity burden, preoperative urinary infections, and inadequate preoperative optimization, which collectively influence overall outcome following TURP.\u003c/p\u003e \u003cp\u003eIn Tanzania, efforts to reduce TURP-related morbidity have focused on adopting bipolar systems, strengthening perioperative monitoring, optimizing haemostasis, and improving surgical training [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. However, evidence on the burden and determinants of TURP complications in the central zone of Tanzania remains limited. Therefore, this study assessed perioperative complications and associated factors among adult men undergoing TURP at Benjamin Mkapa Hospital (BMH) between 2021 and 2023.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy design and setting\u003c/h2\u003e \u003cp\u003eThis was analytical cross-sectional design conducted at Benjamin Mkapa Hospital (BMH) in Dodoma, Tanzania. The hospital is located within the University of Dodoma compounds about 16km from the city center, it serves as a zonal hospital in the central zone of Tanzania. The BMH receives majority of patients from Dodoma, Singida, Tabora, Manyara, Iringa and Morogoro regions. The hospital has a bed capacity of 400 beds with bed occupancy of approximately 200 to 250 patients. Additionally, it is used as a teaching hospital for the University of Dodoma (UDOM). The BMH was established in 2015 with the aim of offering specialized and super specialized services including urologic surgery. The urology department has a bed capacity of 25 beds, 7 urologists and 15 nurses. On average, 20 patients are admitted each month for TURP. The department currently uses a single operating theatre room with a single operating tower.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eStudy population and eligibility\u003c/h3\u003e\n\u003cp\u003eAll adult males aged 40 years and above, who underwent TURP at BMH after being diagnosed with Benign prostate hyperplasia (BPH) between January 2021 and December 2023. The study included patients who had attended clinic for at least one-year post TURP. However, those who had prior history of TURP or any prostate or urethral procedure such as open prostatectomy, Transurethral incision of the prostate (TUIP), Direct visual urethrotomy (DVU), or urethroplasty at other facilities were excluded in the analysis. Likewise, those who had a concurrent condition causing LUTS such as neurogenic bladder, and patients who had incidental prostate cancer were also excluded.\u003c/p\u003e\n\u003ch3\u003eSample size and sampling procedure\u003c/h3\u003e\n\u003cp\u003eA total of 1,029 men aged\u0026thinsp;\u0026ge;\u0026thinsp;40 years underwent TURP between January 2021 and December 2023 at Benjamin Mkapa Hospital (BMH). Among them, 705 met eligibility criteria, and included in the analysis in the study.\u003c/p\u003e\n\u003ch3\u003eData extraction and collection procedure\u003c/h3\u003e\n\u003cp\u003eThe dataset for this study was obtained from the hospital patient record system such as Medipro-5 and Mapping tag ERX hospital system in which the patients\u0026rsquo; records are stored. All the required information was collected in the system by the trained research assistants who used a list of constructed structured questionnaire. A structured questionnaire was developed specifically for this study in data collection. An English-language version of the questionnaire has been provided as Supplementary File 1. After a thorough review of the dataset structure, variable definitions, and coding framework with additional recoding and data cleaning were performed to refine variables and ensure they aligned with the study objectives. These steps were taken to improve the dataset\u0026rsquo;s suitability for statistical analysis. The research team evaluated the collected information by observing the ward rounds notes, follow-up visits notes, laboratory results, imaging results, cystoscopy findings, and urine culture reports. Further, the IPSS recorded pre-operatively and post-operatively 1 year after surgery, were also collected. Other data including mode of TURP performed, preoperative prostate volume, duration of hospital stay, duration of catheterization, duration of medical treatment before TURP, occurrence of TUR syndrome, excessive bleeding, UTI, Urethral stricture, Bladder neck contracture, urinary incontinence, and retrograde ejaculation after TURP were collected.\u003c/p\u003e\n\u003ch3\u003eVariable measurements\u003c/h3\u003e\n\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eDependent variables\u003c/h2\u003e \u003cp\u003eThe dependent/outcome variable of this study was the \u0026ldquo;Complications following TURP\u0026rdquo; procedure. This variable was generated a list of the available outcomes of TURP such as TUR-syndrome; Reported as serum sodium levels of less than 125Meq/L after TURP accompanied with documented symptoms of dilutional hyponatremia in the progress notes, UTI; A positive urine culture of mid-urine-catch within 2 weeks of TURP with least one UTI-causing organism isolated, Excessive hemorrhage; Laboratory results showing HB less than 7g/dl and/or Hematocrit less than 21 within 7 days of TURP or at least 1 blood transfusion administered during perioperative period, Urethral stricture; Urethral lumen less than 16Fr accompanied with LUTS, Excessive hemorrhage; Laboratory results showing HB less than 7g/dl and/or Hematocrit less than 21 within 7 days of TURP or at least 1 blood transfusion administered during perioperative period, Bladder neck contracture; Occurrence of bladder outlet obstruction (BOO) caused by bladder neck stenosis as revealed by cystoscopy findings, Urine incontinence; Occurrence of involuntary loss of urine experienced during the bladder storage phase which occurred at least 6 months post TURP, and Ejaculatory dysfunction: absence or abnormal ejaculation. The outcome variable \u0026ldquo;complications\u0026rdquo; was therefore coded as \u0026ldquo;1\u0026rdquo; to those reported with at least one complication and \u0026ldquo;0\u0026rdquo; otherwise.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eIndependent variables\u003c/h3\u003e\n\u003cp\u003eThe independent variables in this study included participant\u0026rsquo;s age in years, occupation, and place of residence, mode of TURP (bipolar/monopolar), duration of hospital stays in days, duration of catheterization in days, preoperative prostate volume in cubic centimeters, preoperative IPSS, and comorbidities (hypertension, and diabetes).\u003c/p\u003e\n\u003ch3\u003eData analysis plan\u003c/h3\u003e\n\u003cp\u003eWe extracted relevant variables related to TURP surgery performed in 2021 to 2023 from the hospital records, to address the study\u0026rsquo;s objectives. All the analyses were performed using Stata version 17 (Stata Corp, College Station, TX). Descriptive Analysis were summarized using mean and standard deviations for the continuous variables, and percentages for the categorical variables. The proportions of complications following TURP procedure by participant\u0026rsquo;s characteristics was determined to describe its distributions across their levels. The Bivariate and Multivariable modified Poisson regression model for analysis of factors associated with complications among patients who underwent TURP at BMH, was fitted to determine the independent factor contributing to complications following TURP procedure. We fitted a modified Poisson regression models to estimate for the adjusted prevalence ratios (aPRs) with 95% confidence intervals (CIs), with variables of p\u0026thinsp;\u0026lt;\u0026thinsp;0.2 in bivariate analysis be considered in the multivariable analysis, and the statistical significance was set at p\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eEthical consideration\u003c/h2\u003e \u003cp\u003eThe anonymized data used in this study were obtained from the Medipro-5 and Mapping tag ERX hospital system with proper authorization. The extraction process was designed to safeguard privacy and confidentiality to avoid access to personal identifiable information, such as file numbers, in accordance to ethical standards. The ethical approval of using the data was secured from the Benjamin Mkapa Hospital (BMH).\u003c/p\u003e \u003c/div\u003e"},{"header":"RESULTS","content":"\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eCharacteristics of study participants\u003c/h2\u003e \u003cp\u003eA total of 705 participants were recruited for this study. The mean age was 69 years (SD\u0026thinsp;=\u0026thinsp;\u0026plusmn;\u0026thinsp;8.9), with the majority 602 (85.4%), aged 60 years and above. More than two third participants were peasants, accounting for 500 (70.9%), and 539 (76.5%) had NHIF type of insurance. Regarding the surgical procedure, 461 (65.4%) underwent the bipolar mode of operation. Preoperatively, most participants were hospitalized for five days or less 632 (89.7%) and had catheterization for no more than three days 686 (97.3%). Additionally, 532 (75.5%) had a preoperative prostate size of less than 80 cm\u0026sup3;, with the mean preoperative IPSS (SD) of 27.2 (SD\u0026thinsp;=\u0026thinsp;\u0026plusmn;\u0026thinsp;3.3). Concerning comorbidities, 261 (37.1%) had hypertension, while a smaller proportion of 50 (7.1%), had diabetes \u003cb\u003e(\u003c/b\u003eTable\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e\u003cb\u003e).\u003c/b\u003e\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCharacteristics of the study participants (N\u0026thinsp;=\u0026thinsp;705)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFrequency n (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMean age (years)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e69\u0026thinsp;\u0026plusmn;\u0026thinsp;8.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge in years\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e40\u0026ndash;59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e103 (14.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e602 (85.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eOccupation\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCivil servant\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e21 (3.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePeasant\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e500 (70.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEntrepreneur\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e32 (4.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRetired\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e152 (21.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eInsurance type\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNHIF\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e539 (76.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eJWTZ\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e20 (2.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSelf-supported\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e146 (20.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eResidence\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDodoma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e456 (64.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRegions bordering Dodoma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e155 (22.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOther TZ regions\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e94 (13.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTURP mode\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBipolar\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e461 (65.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMonopolar\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e244 (34.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHospitalization time (days)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStandard (\u0026le;\u0026thinsp;5 days)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e632 (89.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProlonged (\u0026gt;\u0026thinsp;5 days)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e73 (10.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCatheterization time (days)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStandard (\u0026le;\u0026thinsp;3 days)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e686 (97.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProlonged (\u0026gt;\u0026thinsp;3 days)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e19 (2.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eFinasteride use duration in months (n\u0026thinsp;=\u0026thinsp;703)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNot recommended (\u0026lt;\u0026thinsp;6 months)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e478 (68.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRecommended (\u0026ge;\u0026thinsp;6 months)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e225 (32.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePre-op prostate volume (\u003c/b\u003ecm\u003csup\u003e3\u003c/sup\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e173 (24.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e532 (75.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHypertension (n\u0026thinsp;=\u0026thinsp;703)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e442 (62.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e261 (37.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDiabetes (n\u0026thinsp;=\u0026thinsp;704)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e654 (92.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e50 (7.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePreoperative IPSS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e27.2\u0026thinsp;\u0026plusmn;\u0026thinsp;3.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProstate Volume (cm\u003csup\u003e3\u003c/sup\u003e): median (IQR)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e64 (IQR\u0026thinsp;=\u0026thinsp;53\u0026ndash;80)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHospitalization time (days): median (IQR)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5 (IQR\u0026thinsp;=\u0026thinsp;5\u0026ndash;5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCatheterization time (days): median (IQR)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2(IQR\u0026thinsp;=\u0026thinsp;2\u0026ndash;2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFinasteride use duration (months)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6 (IQR\u0026thinsp;=\u0026thinsp;3\u0026ndash;8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eIQR: Interquartile range\u003c/h2\u003e \u003cdiv id=\"Sec15\" class=\"Section3\"\u003e \u003ch2\u003eProportion of participants with various kind of complications following TURP\u003c/h2\u003e \u003cp\u003eOut of the 705 men who underwent TURP surgery at BMH, 132 (18.7%) had at least one complication following TURP procedure. Various kinds of complications, with ejaculatory dysfunction contributing highest proportion of 10.4%, followed by urethral stricture with 4.5%. However, among all the participants 28% reported that they were not sexually active. Other complications, include surgical redo, urinary tract infection, clot retention, TUR syndrome, blood transfusion and urine incontinence \u003cb\u003e(\u003c/b\u003eFig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e\u003cb\u003e).\u003c/b\u003e These complications were classified using the Clavien-Dindo system, a standardized method for grading the severity of surgical complications, including those after TURP [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. Among the 705 patients, 10.4% were grade I (e.g., ejaculation dysfunction) requiring no intervention, 2.3% were grade II (e.g., UTI, blood transfusion, urine incontinence) requiring medical treatment, 7.6% were grade III (e.g., urethral stricture, bladder neck contracture, clot retention) requiring surgery, and 0.6% were grade IV (TUR syndrome), representing life-threatening complications \u003cb\u003e(\u003c/b\u003eFig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e\u003cb\u003e).\u003c/b\u003e\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003eProportion of complications by participant characteristics\u003c/h2\u003e \u003cp\u003eOverall, 18.7% of participants experienced at least one complication following the TURP procedure. A significantly higher proportion of complications occurred among men aged\u0026thinsp;\u0026ge;\u0026thinsp;60 years (68.2%) compared to those aged 40\u0026ndash;59 years (31.8%) (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Peasant workers also exhibited a higher proportion of complications (62.1%, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) relative to participants in other occupations. Although complications were more frequently observed among men operated using the bipolar technique (64.4% vs. 35.6%), this difference was not statistically significant (p\u0026thinsp;=\u0026thinsp;0.792). Both hospitalization duration and catheterization time showed statistically significant associations with complications (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001 for each). Regarding the comorbidities, hypertensive patients had a significantly lower proportion of complications compared to non-hypertensive men (53.0% vs. 47.0%). Diabetes status was also significantly associated with postoperative complications, with 15.2% of complications occurring in men with diabetes and 84.8% in those without diabetes (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) \u003cb\u003e(\u003c/b\u003eTable\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e\u003cb\u003e).\u003c/b\u003e\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eProportion of complications by participant characteristics (N\u0026thinsp;=\u0026thinsp;705)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eTotal (N)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eWith Complication\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003en (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e705\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18.7\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge group\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e40\u0026ndash;59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e103\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e42 (31.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e602\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e90 (68.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eOccupation\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCivil servant\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e11 (8.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePeasant\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e500\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e82 (62.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEntrepreneur\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e7 (5.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRetired\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e152\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e32 (24.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eType of insurance\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.014\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNHIF\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e539\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e104 (78.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eJWTZ\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e8 (6.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSelf-supported\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e146\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e20 (15.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eResidence\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.219\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDodoma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e456\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e77 (58.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRegions bordering Dodoma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e155\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e33 (25.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOther TZ regions\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e94\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e22 (16.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTURP mode\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.792\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBipolar\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e461\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e85 (64.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMonopolar\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e244\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e47 (35.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHospitalization time\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStandard (\u0026le;\u0026thinsp;5 days)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e632\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e106 (80.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProlonged (\u0026gt;\u0026thinsp;5 days)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e26 (19.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCatheterization time\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStandard (\u0026le;\u0026thinsp;3 days)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e686\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e119 (90.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProlonged (\u0026gt;\u0026thinsp;3 days)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e13 (9.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eFinasteride use duration\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.162\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNot recommended (\u0026lt;\u0026thinsp;6 months)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e478\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e83 (62.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRecommended (\u0026ge;\u0026thinsp;6 months)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e225\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e49 (37.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eProstate size (cm\u003c/b\u003e\u003csup\u003e\u003cb\u003e3\u003c/b\u003e\u003c/sup\u003e\u003cb\u003e)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.138\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e173\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e39 (29.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e532\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e93 (70.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHypertension\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.009\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e442\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e70 (53.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e261\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e62 (47.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDiabetes\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e654\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e112 (84.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e20 (15.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003eAdjusted prevalence ratios (aPR) for factors associated with complications following TURP among patients at BMH\u003c/h2\u003e \u003cp\u003eIn the adjusted analysis, increasing age (aPR\u0026thinsp;=\u0026thinsp;1.11, 95% CI: 1.11\u0026ndash;1.13, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), prolonged catheterization (\u0026gt;\u0026thinsp;3 days) (aPR\u0026thinsp;=\u0026thinsp;3.10, 95% CI: 1.58\u0026ndash;6.06, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), hypertension (aPR\u0026thinsp;=\u0026thinsp;1.30, 95% CI: 1.09\u0026ndash;1.24, p\u0026thinsp;=\u0026thinsp;0.008), and diabetes (aPR\u0026thinsp;=\u0026thinsp;1.85, 95% CI: 1.22\u0026ndash;2.80, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) were significantly associated with a higher prevalence of post-TURP complications. Men who underwent the monopolar procedure had a lower prevalence of complications compared with those who received the bipolar technique (aPR\u0026thinsp;=\u0026thinsp;0.91, 95% CI: 0.67\u0026ndash;1.25), although this association was not statistically significant (p\u0026thinsp;=\u0026thinsp;0.575) \u003cb\u003e(\u003c/b\u003eTable\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e\u003cb\u003e).\u003c/b\u003e\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eBivariate and Multivariable analysis of factors associated with complications following TURP among men with benign prostatic hyperplasia at BMH (N\u0026thinsp;=\u0026thinsp;705)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003ecPR (95% CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eaPR (95% CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.13 (1.10\u0026ndash;1.14)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e1.1 (1.11\u0026ndash;1.13)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eOccupation\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCivil servant\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eref\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eref\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePeasant\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.31 (0.20\u0026ndash;0.49)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.99 (0.54\u0026ndash;1.83)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.983\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEntrepreneur\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.42 (0.19\u0026ndash;0.90)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.027\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.78 (0.35\u0026ndash;1.72)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.532\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRetired\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.40 (0.24\u0026ndash;0.67)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.14 (0.60\u0026ndash;2.17)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.693\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eResidence\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDodoma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eref\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBordering Regions\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.26 (0.88\u0026ndash;1.82)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.213\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOther TZ Regions\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.39 (0.91\u0026ndash;2.11)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.127\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTURP Mode\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBipolar\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eref\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eref\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMonopolar\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.04 (0.76\u0026ndash;1.44)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.789\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.91 (0.67\u0026ndash;1.25)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.575\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDuration of Hospital Stay\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026le;\u0026thinsp;5 days\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eref\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eref\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;5 days\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.12 (1.49\u0026ndash;3.03)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.38 (0.87\u0026ndash;2.19)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.176\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDuration of Catheterization\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026le;\u0026thinsp;3 days\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eref\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eref\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;3 days\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.94 (2.79\u0026ndash;5.58)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e3.10 (1.58\u0026ndash;6.06)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDuration of finasteride use\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;6 months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eref\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eref\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;6 months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.25 (0.91\u0026ndash;1.72)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.23 (0.91\u0026ndash;1.66)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.174\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eProstate Size (cm\u003c/b\u003e\u003csup\u003e\u003cb\u003e3\u003c/b\u003e\u003c/sup\u003e\u003cb\u003e)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eref\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eref\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.78 (0.56\u0026ndash;1.08)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.134\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.81 (0.58\u0026ndash;1.13)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.209\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePreoperative IPSS\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.05 (1.00\u0026ndash;1.11)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.034\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.02 (0.97\u0026ndash;1.07)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.402\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHypertension\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eref\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eref\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.50 (1.10\u0026ndash;2.04)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.009\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e1.30 (1.09\u0026ndash;1.24)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.008\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDiabetes\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eref\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eref\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.34 (1.60\u0026ndash;3.41)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e1.85 (1.22\u0026ndash;2.80)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003ecPR: Crude prevalence ratio, aPR: adjusted prevalence ratio, CI: confidence interval\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study assessed postoperative complications and associated factors among 705 men undergoing transurethral resection of the prostate (TURP) at Benjamin Mkapa Hospital (BMH). Nearly one-fifth of patients (18.7%) experienced at least one complication following TURP, a prevalence that aligns with international estimates of 10\u0026ndash;20% reported in large multicentre analyses [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e] and summarized in the European Association of Urology (EAU) guidelines [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn this study, ejaculatory dysfunction was the most common complication, occurring in 10.4% of patients, which is noticeably lower than the 30\u0026ndash;70% reported in Western populations. For instance, a systematic review of TURP trials reported retrograde ejaculation in approximately 46% of patients [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e] while other reviews and cohort studies have documented rates of 47\u0026ndash;65% after TURP [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. This comparatively lower rate may partly reflect reduced sexual activity in older Tanzanian men, cultural reluctance to report sexual issues, and poor routine postoperative sexual function assessment issues echoed in sub-Saharan urological studies where underreporting of sexual complications is common. We found that, Urethral stricture (4.5%) was among the leading severe complications, consistent with internationally reported post‑TURP stricture rates ranging from 2\u0026ndash;10% [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e], with bipolar TURP reported a rate of 4.3% [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e], and 3.9% rate in monopolar procedure [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. In Tanzania, several possible contextual factors, including delayed health seeking behaviour, recurrent UTIs before surgery, and limited access to specialized postoperative follow-up may exacerbate stricture risk compared to high-resource settings [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. Local studies have similarly emphasized late presentation and high baseline comorbidity burden among BPH patients, contributing to postoperative morbidity [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eWe found that advancing age was strongly associate with postoperative complications. This finding consistent a recent study of elderly men (\u0026ge;\u0026thinsp;80 years) undergoing TURP reported a 30-day complication rate of 9.5% which indicate a higher perioperative risk in older patients [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. Additionally, another large cohort study found that early urethral stricture occurred in 3.9% of TURP patients, and identified higher comorbidity burden (which increases with age) as an independent risk factor for stricture formation [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. These findings support the increased vulnerability of older men to TURP complications, underscoring the need for cautious preoperative assessment and optimization in older patients in our setting.\u003c/p\u003e \u003cp\u003eProlonged catheterization (\u0026gt;\u0026thinsp;3 days) was associated with higher complication rates in our study, which could reflect increased risk of catheter associated infection, mucosal irritation, or catheter-related trauma. While some studies outside the TURP setting report that longer indwelling catheter time increases urinary tract infections and other morbidity, and one small bipolar-TURP series noted an association between extended catheter dwell time and stricture formation [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e], large TURP-specific series often identify other risk factors, including prolonged operative time and comorbidity burden rather than catheter duration itself [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. With this limited and inconsistent evidence, in resource limited settings like Tanzania, where postoperative monitoring and catheter care may be suboptimal, it is plausible that prolonged catheterization adds risk, though causality cannot be firmly established.\u003c/p\u003e \u003cp\u003eIn this study, we found that hypertension and diabetes was significant determinants of postoperative complications. This result is consistent with wide-ranging surgical evidence indicating that metabolic and vascular diseases impair wound healing and increase the risk of postoperative morbidity. For example, a recent meta-analysis found that diabetes mellitus raised the risk of any postoperative complication, including infections, reoperations, and wound healing disorders [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. Similarly, evidence show that poor glycaemic control has been strongly associated with delayed wound healing, surgical site infections, dehiscence, and extended hospital stays in multiple surgical cohorts [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. Therefore, in the settings like Tanzania where chronic disease control is often suboptimal, comorbid hypertension or diabetes may significantly elevate the risk of complications after TURP.\u003c/p\u003e \u003cp\u003eFinally, we found that mode of TURP (monopolar versus bipolar) was not significantly associated with complications. This is consistent with randomized trials and meta-analyses showing broadly comparable overall safety and functional outcomes between monopolar and bipolar TURP, despite some advantages of bipolar systems in reducing TUR syndrome and blood loss [\u003cspan additionalcitationids=\"CR33\" citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]. For resource-limited settings such as Tanzania, potential benefits of bipolar TURP may be lessened by variability in experienced surgeon, with equipments, and patient comorbidity profiles.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eIn this study of men undergoing TURP at Benjamin Mkapa Hospital, nearly 20% of them experienced postoperative complications, predominantly mild to moderate. Ejaculatory dysfunction and urethral stricture were the most frequent. Advanced age, prolonged catheterization, hypertension, and diabetes were significant independent predictors, highlighting the need for targeted preoperative assessment and optimization to reduce complication risk and improve surgical outcomes.\u003c/p\u003e \u003cdiv id=\"Sec20\" class=\"Section2\"\u003e \u003ch2\u003eRecommendations\u003c/h2\u003e \u003cp\u003eTo reduce TURP complications in Tanzania, preoperative optimization of comorbidities such as hypertension and diabetes is essential, especially in older patients. Postoperative care should focus on minimizing catheterization duration and ensuring structured follow-up for early detection of complications. Strengthening surgical capacity through training, and proper perioperative monitoring is critical. Additionally, patient education on catheter care, warning signs, and expected outcomes, along with maintaining a TURP outcomes registry, can improve surgical safety and quality of care. Future research should focus on prospective, multicenter studies to evaluate intraoperative factors, long-term outcomes, and strategies to reduce TURP complications in low-resource settings.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec21\" class=\"Section2\"\u003e \u003ch2\u003eStrengths and Limitations\u003c/h2\u003e \u003cp\u003eThis study has several strengths, including the use of large sample size of 705 patients and the use of routinely collected hospital data, providing real-world insights. Analysis of independent variables offers practical guidance for perioperative care, and the findings address a knowledge gap in Tanzania and similar settings. However, the retrospective single-center design may limit generalizability, and some clinical variables, such as intraoperative blood loss, surgeon experience, and detailed prostate characteristics, were not captured. Mild or late complications may have been underreported, and unmeasured confounders like lifestyle and socioeconomic factors could influence outcomes.\u003c/p\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eFunding statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study did not receive funding.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo competing interest between authors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEthical approval for this study was obtained from the Institutional Research Review Ethics Committee (IRREC) of the University of Dodoma. Permission to access and use secondary data was granted by the Office of the Vice Chancellor, University of Dodoma, and the Executive Director of Benjamin Mkapa Hospital (BMH). As the study involved de-identified secondary data with no direct contact with participants, the requirement for informed consent was waived. The study adhered to the ethical principles of the Declaration of Helsinki. Participant confidentiality was ensured through the use of unique identification codes, and all data were securely stored and accessible only to authorized personnel.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe dataset, materials, and codes used to produce this manuscript is available upon request to the corresponding author and Benjamin Mkapa Hospital administration.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eConceptualization, GPM, ET, HIH, EM, RR, OS, VK, and JE; methodology, GPM, SSK, SAK, and AML; software, GPM, AML and SSK; formal analysis, GPM, and SSK; data curation, GPM, AML, HIH, and SAK; writing - original draft, GMP, ET, and HIH; writing - review and editing, GPM, ET, HIH, BE, AML, SSK, EM, SAK, SM, OS, VK, RR, JE, MK, AC, and AM; visualization, GMP; supervision, BE, AML, MC, AC, and AM; Resources, AM. All authors have read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAuthors acknowledge the Benjamin Mkapa Hospital (BMH) for their administrative support and permission to use data in this study. We acknowledge the participants who provided the information for the whole study period. We also appreciate data collectors and individual researcher contributions for their dedication to conducting this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical Trial Number:\u0026nbsp;\u003c/strong\u003eNot Applicable\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eShunming J, Mun Y, Sien S, Ho H. ScienceDirect An update on transurethral surgery for benign prostatic obstruction. Asian J Urol. 2017;(June):122\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePartin DK. In: Partin AW, editor. Campbell-Walsh-Wein Urology. 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Association of Diabetes Mellitus With Postoperative Complications and Mortality After Non-Cardiac Surgery: A Meta-Analysis and Systematic Review. Front Endocrinol (Lausanne). 2022;13:841256.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFadhil T, Batool A, Khan H, Farooq MS. Wound Healing in Diabetic Patients Undergoing Abdominal Surgery: A Retrospective Study. Cureus 17(8):e90132.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSinha MM, University Hospital Southampton NHS, Foundation Trust, Southampton UK, Pietropaolo A, University Hospital Southampton NHS, Foundation Trust, Southampton UK, Hameed BMZ et al. Department of Urology, Father Muller Medical College, Karnataka, India,. Outcomes of bipolar TURP compared to monopolar TURP: A comprehensive literature review. Turkish Journal of Urology. 2022;48(1):1\u0026ndash;10.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMamoulakis C, Ubbink DT, de la Rosette JJMCH. Bipolar versus Monopolar Transurethral Resection of the Prostate: A Systematic Review and Meta-analysis of Randomized Controlled Trials. Eur Urol. 2009;56(5):798\u0026ndash;809.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHueber PA, Al-Asker A, Zorn KC. Monopolar vs. bipolar TURP: assessing their clinical advantages. cuaj. 2011;5(6):390\u0026ndash;1.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-urology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"buro","sideBox":"Learn more about [BMC Urology](http://bmcurol.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/buro/default.aspx","title":"BMC Urology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"TURP, complications, benign prostate enlargement, Tanzania, urology","lastPublishedDoi":"10.21203/rs.3.rs-8231557/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8231557/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eIntroduction:\u003c/h2\u003e \u003cp\u003eTransurethral resection of the prostate (TURP) remains the gold standard surgical treatment for moderate to severe lower urinary tract symptoms (LUTS) secondary to benign prostate enlargement (BPE). Despite its effectiveness, TURP is associated with several perioperative complications which varies across settings. In Tanzania, evidence on complication rates and associated factors remains limited. This study assessed the prevalence and determinants of perioperative complications following TURP at Benjamin Mkapa Hospital between 2021 and 2023.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eAn analytical cross-sectional study was conducted using routinely collected data from the Medipro-5 and Mapping Tag ERX systems at BMH, included men aged\u0026thinsp;\u0026ge;\u0026thinsp;40 years diagnosed with BPH who underwent TURP and had at least one year of postoperative follow-up. Patients with prior prostate/urethral surgery, neurogenic bladder, or incidental prostate cancer were excluded. Descriptive statistics summarized patient characteristics. Modified Poisson regression with robust error variance estimated crude and adjusted prevalence ratios (aPRs) with 95% confidence intervals (CIs) for factors associated with complications, and p\u0026thinsp;\u0026lt;\u0026thinsp;0.05 being considered statistically significance.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eAmong 705 eligible men (mean age 69\u0026thinsp;\u0026plusmn;\u0026thinsp;8.9 years), 18.7% experienced at least one complication. Ejaculatory dysfunction (10.4%) and urethral stricture (4.5%) were the most frequent complications. Based on the Clavien-Dindo classification: 10.4% were grade I, 2.3% grade II, 7.6% grade III, and 0.6% grade IV. In adjusted analysis, increasing age (aPR\u0026thinsp;=\u0026thinsp;1.11; 95% CI: 1.11\u0026ndash;1.13), catheterization\u0026thinsp;\u0026gt;\u0026thinsp;3 days (aPR\u0026thinsp;=\u0026thinsp;3.10; 95% CI: 1.58\u0026ndash;6.06), hypertension (aPR\u0026thinsp;=\u0026thinsp;1.30; 95% CI: 1.09\u0026ndash;1.24), and diabetes (aPR\u0026thinsp;=\u0026thinsp;1.85; 95% CI: 1.22\u0026ndash;2.80) were significantly associated with higher prevalence of complications. However, TURP mode showed no significant association (p\u0026thinsp;=\u0026thinsp;0.575)\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eNearly one-fifth of men undergoing TURP at BMH developed postoperative complications, mostly mild but clinically important. Older age, prolonged catheterization, hypertension, and diabetes increased complication risk. Strengthening perioperative optimization may improve outcomes\u003c/p\u003e","manuscriptTitle":"Perioperative Complications and Associated Factors Following Transurethral Resection of the Prostate Among Patients at Benjamin Mkapa Hospital, Tanzania","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-01-13 09:27:00","doi":"10.21203/rs.3.rs-8231557/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-02-12T09:27:36+00:00","index":"","fulltext":""},{"type":"reviewerAgreed","content":"131387020762639547635551478517588448364","date":"2026-02-08T18:23:13+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-02-08T14:44:52+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"225179334183163700575403327893999698014","date":"2026-02-05T07:04:01+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"242333747798982718927767431832047854019","date":"2026-02-03T12:44:52+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-01-24T11:44:34+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"105780805369705951223220170846821359546","date":"2026-01-18T20:46:29+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-01-17T06:36:57+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"81038329379690054534398268290741777631","date":"2026-01-09T00:29:00+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-01-08T16:47:57+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-01-05T12:31:54+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-12-12T21:06:17+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-12-11T11:40:47+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Urology","date":"2025-12-11T11:32:35+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-urology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"buro","sideBox":"Learn more about [BMC Urology](http://bmcurol.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/buro/default.aspx","title":"BMC Urology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"55d4f66b-10b6-4902-a5ac-1f92380ff105","owner":[],"postedDate":"January 13th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-05-17T05:38:56+00:00","versionOfRecord":[],"versionCreatedAt":"2026-01-13 09:27:00","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8231557","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8231557","identity":"rs-8231557","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}