Impact of Changing Trends in Medical Therapy on Surgery for Benign Prostatic Hyperplasia Over Two Decades

Abstract

PurposeFollowing the introduction of medical therapy for benign prostatic hyperplasia (BPH), we determined the effect of the change in trends in medical therapy on the indication and outcome of surgical intervention for BPH.Materials and MethodsWe compared the basic characteristics of, weight of resected tissue of, transfusions in, and postoperative complications of patients who underwent surgery between 1985 and 1989 (before the advent of medical therapy for BPH), between 1995 and 1999 (when medical therapy was developed and became widely used as alternative treatment), and between 2005 and 2009 (when medical therapy superseded surgical intervention to become first-line treatment and when combination therapy became widely adopted).ResultsAt our institution, the mean age and BMI of patients increased over the past two decades (p<0.001). Hypertension, operation history, and other comorbidities also increased significantly (p<0.001, p=0.005, and p<0.001, respectively). The indications for surgery in 1985 to 1989, 1995 to 1999, and 2005 to 2009 were as follows: acute urinary retention in 34.7%, 20.2%, and 15.1% of patients and symptomatic deterioration in 61.1%, 72.3%, and 73.0% of patients, respectively. Prostate volume and the weight of resected tissue increased from 34.4±14.5 ml to 61.3±32.4 ml and from 7.2±6.4 g to 10.8±7.6 g, respectively, over two decades. Patients who underwent surgery in 2005 to 2009 had their catheters removed earlier (p<0.001). Secondary hemorrhage within four postoperative weeks and repeat transurethral resection of the prostate within 1 year decreased significantly (p=0.03 and p=0.003, respectively). No statistically significant change in impaired detrusor contractility was found (p=0.523).ConclusionsAlthough patients who underwent surgery were older after widespread use of medical therapy for BPH, advancements in surgical techniques have benefitted these patients.

Efficacy and safety of prostate artery embolization on lower urinary tract symptoms related to benign prostatic hyperplasia: a systematic review and meta-analysis

“…They have increased operative risk of undergoing TURP/open surgery or refuse any surgical treatment 18. In this meta-analysis, for large volume (PV ≥80 mL) BPH, there were significant improvements in the IPSSs (−18.32 points), QoL scores (−2.50 points), PV (−47.58 mL), Q max (+6.00 mL/s) and PVR volume (−76.80 mL) after PAE during the 12-month follow-up, and there were no life-threatening complications.…”

Comparative Effects of Roystonea Regia (D-004) and Saw Palmetto Lipid Extracts On Blood Oxidative Variables in Men with Benign Prostate Hyperplasia (BPH)

“…Both groups had similar baseline characteristics, so that they were homogeneous for comparisons. Study subjects were men (average age: 65 years) with moderate BPH (IPSS values ≥ 7, but 19), and with several co-morbidities (hypertension diabetes, dyslipidemia and obesity) characteristic of this population [35,36]. Concomitant medications were consistent with the personal history of the patients.…”

Changing patients’ profile presenting for surgical management of benign prostatic hyperplasia over the past 16 years: A single-centre perspective

“…10 Furthermore, as the population ages, more and more people will require medical care. 11 Any delay in surgical therapy, when indicated, can cause progression of BPH and worsen its symptoms.…”

“…In addition, significant comorbidities including increased body mass index, chronic medical diseases and operative history have increased in the last two decades for patients with symptomatic BPH. 10 In the current study, we compared 3 consecutive timebased groups of BPH patients surgically treated with different modalities of Holmium and GreenLight lasers, including ablation, incision and enucleation procedures. We found that preoperative prostate volume significantly correlated with age at surgery, total energy used at surgery, and the total operative time.…”