Mortality and Reoperation after Open and Transurethral Resection of the Prostate for Benign Prostatic Hyperplasia

Abstract

As part of an ongoing effort to evaluate alternative treatments for benign prostatic hyperplasia, we compared the outcomes of transurethral resection of the prostate with those of open prostatectomy. Men undergoing prostatectomy in Denmark (n = 36,703), Oxfordshire, England (n = 5284), and Manitoba, Canada (n = 12,090), were identified retrospectively through administrative data and followed for up to eight years. The cumulative percentage of patients undergoing a second prostatectomy was substantially higher after transurethral than after open prostatectomy (12.0 vs. 4.5 percent in Denmark, 12.0 vs. 1.8 percent in Oxfordshire, and 15.5 vs. 4.2 percent in Manitoba). The long-term age-specific mortality rates associated with transurethral prostatectomy as compared with open prostatectomy were also elevated in each country. The data on 1650 Canadian patients were used to investigate the contribution of coexisting morbid conditions to the elevated risk of death. The relative risk was 1.45 (95 percent confidence interval, 1.15 to 1.83) before risk adjustment and 1.45 (95 percent confidence interval, 1.15 to 1.84) after adjustment; the higher mortality was seen among low-risk as well as high-risk patients. These findings suggest that transurethral prostatectomy is less effective in overcoming urinary obstruction than the open operation. Our data also raise the possibility that transurethral prostatectomy may result in higher long-term mortality, although we cannot rule out potential confounding effects of unmeasured characteristics of patients.

Overview of Benign and Malignant Prostatic Disease in Pakistani Patients: A Clinical and Histopathological Perspective

“…As seen in our results, most cases of BPH are treated by TUR rather than suprapubic prostatectomy, although studies have shown that chances of a patient undergoing another surgery for BPH is much higher after TUR than suprapubic prostatectomy (Roos et al, 1989). The mean weight of BPH specimens in our series was 19 grams for TUR and 43 grams for enucleation specimens.…”

Overcoming potential pitfalls in the use of Medicare data for epidemiologic research.

“…Medicare files have been used to study disease incidence and risk factors,1-3 to document regional variations in treatment patterns,4 5 to study hospital-associated mortality rates and quality of care,6 and to evaluate the outcomes of specific surgical and medical treatments. 7,8 Most concern about the validity of research findings based on the Medicare files has focused on issues related to the accuracy of diagnostic coding.9-" In this paper we highlight several other potential limitations of the Medicare data relevant to epidemiologic research by addressing two questions. First, can one assume that the population captured in Medicare files is the same as the elderly population of the United States?…”

Surgical management of benign prostatic hyperplasia

“…Hemostaza se, među ostalim, postiže uz pomoć postavljanja balona trokrakog katetera u ležište prostate. Prednost otvorene prostatektomije pred transvezikalnom resekcijom prostate je manja učestalost ponovnog tretmana, kompletnije odstranjenje adenoma te izostanak TUR sindroma 10 . Nedostatak je potreba za incizijom trbušne stjenke, čime se produljuje poslijeoperativni oporavak, veća učestalost krvarenja koje zahtijeva trans fuziju, mogućnost ozljede sfinktera i rektuma te produljena urinarna kateterizacija 11 .…”