Benign prostatic hyperplasia in sweden 1987 to 1994: changing patterns of treatment, changing patterns of costs

Blomqvist, Peter; Ekbom, Anders; Carlsson, Per; Ahlstrand, Christer; Johansson, Jan‐Erik

doi:10.1016/s0090-4295(97)00241-0

Cited by 21 publications

(9 citation statements)

References 15 publications

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“…1 However, the increasing use of other treatment modalities has led to a decline in numbers. 6,7 Our study has confirmed this downward trend, albeit with smaller numbers. One possible explanation for this decrease in numbers over the 10-year period is a decrease in available hospital resources (e.g.…”

Section: Discussionsupporting

confidence: 75%

“…5,6 Not surprisingly, therefore, the number of TURPs performed is in decline; a 43% decrease was observed in the US between 1987 and 1994 6 and this decline has also been recorded in Europe. 7 This study was undertaken to see if TURPs were being performed less frequently over a specific time period in a busy district hospital in the UK. It would also be possible to see whether the indications for TURP had changed and indeed whether TURP was now being performed on a different population than it had been.…”

mentioning

confidence: 99%

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The changing practice of transurethral prostatectomy: a comparison of cases performed in 1990 and 2000

Wilson

Urwin²,

Stower³

2004

Ann R Coll Surg Engl

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F or many decades, transurethral resection of the prostate (TURP) has been considered the 'gold standard' surgical treatment 1 for lower urinary tract symptoms (LUTS) resulting from benign prostatic hyperplasia (BPH) or cancer and its complications. Mebust et al., 2 in a review of 3885 patients, reported a risk of 2% of developing TUR syndrome, with 3.9% of patients requiring a postoperative blood transfusion, 6.5% failing to void (presumably as a result of initial detrusor failure), and secondary haemorrhage in 3.3%. This paper quoted an overall procedural mortality of 0.23%. Alternative methods of treatment have, therefore, been sought, and over the past 15 years there has been an increasing usage of pharmacological therapy (e.g. 5α-reductase inhibitors, α 1 -receptor antagonists)3,4 and attempts to devise minimally invasive surgical alternatives (e.g. transurethral microwave thermotherapy). 5,6 Not surprisingly, therefore, the number of TURPs performed is in decline; a 43% decrease was observed in the US between 1987 and 1994 6 and this decline has also been recorded in Europe. 7 This study was undertaken to see if TURPs were being performed less frequently over a specific time period in a busy district hospital in the UK. It would also be possible to see whether the indications for TURP had changed and indeed whether TURP was now being performed on a different population than it had been. These data would also enable an assessment of the different rates of complications over the time periods analysed. Results: There was a decline in the number of TURPs performed of 31.6% over the 10-year period, with more being carried out because of urinary retention. In 2000, the patient was older and the operative procedure took statistically longer than 10-years earlier, but the weight of prostate tissue resected, patient satisfaction and complication rates were similar. Conclusions: At present, TURP is in decline, with urinary retention being the commonest indication. The population at present is older but this does not carry additional co-morbidity. The weight of resection has not altered, although surgery currently takes longer to perform.

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Section: Discussionsupporting

confidence: 75%

mentioning

confidence: 99%

The changing practice of transurethral prostatectomy: a comparison of cases performed in 1990 and 2000

Wilson

Urwin²,

Stower³

2004

Ann R Coll Surg Engl

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“…General health may have been one such factor influencing selection of BPH treatment. In this study, the TA subcohort is generally healthiest, followed by the TURP group and then the non-surgical group, as evidenced by lower mortality rates from non-GU comorbidities, including cardiovascular disease, diabetes mellitus and respiratory disease (Blomqvist et al, 1997). In addition, the index hospital discharge diagnosis of BPH was the primary diagnosis for only 53% of non-surgical patients, compared with 89 and 88% of TA and TURP participants, respectively (Blomqvist et al, 1997), suggesting that those undergoing surgery were less likely to have other health concerns.…”

Section: Discussionmentioning

confidence: 85%

“…This finding could result from long latency of bladder cancer development, which is supported by the finding that increased risk of bladder cancer was more pronounced in BPH cases with follow-up of greater than 10 years. Alternatively, it could result from changes in medical practice, such as differences in the recommendations for TURP over time (Blomqvist et al, 1997). In Sweden, the use of TURP grew over the study period (B20% of BPH patients for pre-1975, B60% for post-1975).…”

Section: Discussionmentioning

confidence: 99%

“…Although TURP is regarded as the gold standard for the management of BPH, follow-up studies reveal failures and complications in 1 -18% of patients (Mebust et al, 1989;Faul, 1993;Blomqvist et al, 1997;Borth et al, 2001). Compared with TA, TURP treatment may not completely excise the enlarged prostate, and it is possible that incomplete BPH treatment may increase the risk of BPH-related adverse effects, such as urinary retention, post-void residual urine, and other urinary symptoms, which may, in turn, increase the risk of bladder cancer.…”

Section: Discussionmentioning

confidence: 99%

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Benign prostatic hyperplasia and subsequent risk of bladder cancer

et al. 2007

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We evaluated the risk of bladder cancer in a cohort of 79 280 Swedish men hospitalised for benign prostatic hyperplasia (BPH), identified in the Swedish Inpatient Register between 1964 and 1983 and followed until 1989 via multiple record linkages with nationwide data on cancer registry, death and emigration. Standardised incidence ratios (SIRs), the ratios of the observed to the expected numbers of incident bladder cancers, were used to calculate the risk associated with BPH. The expected number was calculated by multiplying the number of person-years by the age-specific cancer incidence rates in Sweden for each 5-year age group and calendar year of observation. Analyses were stratified by BPH treatment, latency, calendar year and presence of genitourinary (GU) comorbid conditions. After excluding the first 3 years of follow-up after the index hospitalisation, we observed 506 incident bladder cancer cases during follow-up in the cohort. No overall increased risk of bladder cancer was apparent in our main analysis involving the entire BPH cohort. However, among BPH patients with transurethral resection of the prostate (TURP), there was an increased risk in all follow-up periods; SIRs of bladder cancer during years 4 -6 of follow-up was 1.22 (95% confidence interval ¼ 1.02 -1.46), 1.32 for 7 -9 years of follow-up, and 1.47 for 10 -26 years of follow-up. SIRs of bladder cancer among TURPtreated BPH patients were particularly elevated among those with comorbid conditions of the GU tract (e.g., stone, infection, etc.); 1.72, 1.74 and 2.01 for 4 -6, 7 -9, 10 -26 years of follow-up, respectively, and also for those whose diagnoses occurred before 1975, when TURP was more likely to be performed by a urologist than a general practitioner: 1.87, 1.90 and 1.74, respectively. These findings suggest that BPH overall is not associated with bladder cancer risk. However, among men treated with TURP, particularly those with other comorbid GU tract conditions, risk of bladder cancer was elevated.

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Prostate carcinoma risk subsequent to diagnosis of benign prostatic hyperplasia

Chokkalingam

Nyrén

Johansson

et al. 2003

Cancer

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The performance of a model Pt/BaO/Al2O3 monolith catalyst was studied using H2 as the reductant. The dependence of product selectivities on operating parameters is reported, including the durations of regeneration and storage times, feed composition and temperature, and monolith temperature. The data are explained in terms of a phenomenological model factoring in the transport, kinetic, and spatio‐temporal effects. The Pt/BaO catalyst exhibits high cycle‐averaged NOx conversion above 100°C, generating a mixture of N2 and byproducts NH3 and N2O. The cycle‐averaged NOx conversion exhibits a maximum at about 300°C corresponding to the NOx storage maximum. The N2 selectivity exhibits a maximum at a somewhat higher temperature, at which point the NH3 selectivity exhibits a minimum. This trend conveys the intermediate role of NH3 in reacting with stored NOx. Both N2 and N2O are also formed during the storage steps from the oxidation of NHx species produced during the regeneration. © 2009 American Institute of Chemical Engineers AIChE J, 2009

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Benign prostatic hyperplasia in sweden 1987 to 1994: changing patterns of treatment, changing patterns of costs

Cited by 21 publications

References 15 publications

The changing practice of transurethral prostatectomy: a comparison of cases performed in 1990 and 2000

The changing practice of transurethral prostatectomy: a comparison of cases performed in 1990 and 2000

Benign prostatic hyperplasia and subsequent risk of bladder cancer

Prostate carcinoma risk subsequent to diagnosis of benign prostatic hyperplasia

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