Abstract
<title>Abstract</title> <p> <bold>Purpose</bold> To evaluate whether postoperative improvement in renal function prevents progression to chronic kidney disease (CKD) stage 5 and to identify associated risk factors in patients with CKD and benign prostate hyperplasia after prostate surgery. <bold>Materials and Methods</bold> We retrospectively analysed 175 patients with CKD stage 3–4 among 1,137 who underwent prostate surgery (bipolar transurethral resection of the prostate (B-TURP) or thulium vapo-enucleation of the prostate (ThuVEP)) between 2015 and 2020, with follow-up to 2025. Potential predictors were initially screened using least absolute shrinkage and selection operator (LASSO) regression. Variables identified by LASSO and found statistically significant in Firth’s penalized logistic regression were retained for inclusion in the final model. <bold>Results</bold> In the multivariable Firth logistic regression analysis, lower preoperative GFR, presence of heart disease, and lack of postoperative GFR improvement were significantly associated with progression to CKD stage 5 within 5 years. Each 1 mL/min/1.73m² increase in preoperative GFR was associated with a 10% reduction in odds (OR = 0.898, 95% CI 0.839–0.962, p = 0.002). Patients with heart disease had higher odds of progression compared with those without heart disease (OR = 9.683, 95% CI 1.912–49.037, p = 0.006). Postoperative GFR improvement reduced the odds of progression by 94.7%. (OR = 0.053, 95% CI 0.011–0.254, p < 0.001). <bold>Conclusion</bold> In patients with CKD stage 3–4 and bladder outlet obstruction undergoing surgical treatment, renal functional improvement plays a crucial role in long-term renal outcomes. Lower preoperative eGFR and coexisting heart disease were strong risk factors for progression to CKD stage 5, whereas postoperative improvement in renal function significantly reduced this risk. </p>