The impact of medical therapy on surgery for benign prostatic hyperplasia: a study comparing changes in a decade (1992–2002)

Abstract

OBJECTIVESTo compare the clinical profile (age, comorbidities, symptom severity, and incidence of acute urinary retention, AUR), the type and duration of medical treatment, and indications for surgery of patients undergoing surgery for benign prostatic hyperplasia (BPH) in 1992 and 2002 at one centre. PATIENTS AND METHODSIn this single-centre, retrospective, crosssectional observational study, the medical history of all patients who had surgery for BPH in the first semester of 1992 (85) and 2002 (70) was reviewed. The preoperative clinical profile was determined by assessing age, main comorbidities, prostatic volume, maximum urinary flow rate and symptom severity. The type and duration of pharmacology for BPH was evaluated from the medical history and telephone contact with the patients. Indications for surgery, the method of operation and the weight of removed tissue (open adenectomy) or the volume of the resected tissue (transurethral resection) were obtained from the patients' records and compared. Surgical complications in both groups were assessed, as was the average stay in hospital. RESULTSIn our institution, surgery for BPH decreased by 17.6% in the decade, with patients having surgery when older, at a mean ( SD ) of 69.1 (8.57) vs 72.3 (7.59) years, i.e. 3.1 years older ( P = 0.028), but with similar comorbidities. Reasons for surgery in 1992/ 2002, respectively, were AUR in 41/37%, and symptoms worsening in 48/51%. The few cases of haematuria and bladder stone were similarly distributed in both groups. Pharmacology for BPH was prescribed in 46% of patients in 1992, phytotherapy being the most common (89%), whereas in 2002, 82% ( P < 0.01) were treated, most of them with α -adrenergic antagonists (79%). Open surgery was indicated in 18.8% of patients in 1992 (mean adenoma weight 73.8 g, SD 37.12) and in 28.6% in 2002 (79.8 g, SD 35.41; P = 0.625). The mean ( SD ) hospital stay was 8.9 (4.06) vs 5.0 (1.22) days in 1992 and 2002, respectively ( P < 0.01) for transurethral resection, and 14.1 (5.74) vs 8.7 (4.83) for open adenectomy ( P = 0.013). The complication rate was similar for both groups. CONCLUSIONS

Transurethral resection of the prostate for the treatment of lower urinary tract symptoms related to benign prostatic hyperplasia: how much should be resected?

“…Despite the initial recommendations by Nesbit (5), historical data has shown that the amount of resected tissue has decreased significantly over time (7,8). In the study of Borth et al (7), mean weight of tissue resected in 1988 was 16.5g and decreased to 12.5g in 1998.…”

“…The recommended technique of TURP consists of complete removal of all adenomatous tissue inside the surgical capsule (5). However, complication rates seem to be related to resection time and the amount of resected tissue (6), and historical data has shown that the amount of resected tissue during TURP has decreased significantly over the last 10 years (7,8).…”

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

“…20 Longer medical treatment for BPH has been associated with a decreased number of patients undergoing BPH surgery resulting in increased prostate volume with potentially more patients needing open surgery. 21 The question is whether changes in laser surgery over the past 16 years have been able to sustain surgical outcome despite significant changes in the target population. Fortunately, the currently available new laser technology and equipment confer benefits to these patients and could overcome the challenge of increased prostate volume and patient comorbidities.…”

Efficacy and safety of dutasteride, tamsulosin and their combination in a subpopulation of the CombAT study: 2-year results in Asian men with moderate-to-severe BPH

“…However, it takes a few months before clinical improvement is apparent. [14][15][16][17][18][19][20][21][22] The value of combination therapy with 5ARIs and ablockers over monotherapy with either drug was first demonstrated in the Medical Therapy Of Prostatic Symptoms (MTOPS) study. 23 In men with BPH, combination therapy with finasteride and doxazosin was superior to each monotherapy at 4 years for treatment of LUTS and reducing risk of progression.…”