2086 IMPACT OF MEDICAL THERAPY ON TRANSURETHRAL RESECTION OF THE PROSTATE (TURP): TWO DECADES OF CHANGE

You have accessJournal of UrologyBenign Prostatic Hyperplasia: Surgical Therapy and New Technology II1 Apr 20102086 IMPACT OF MEDICAL THERAPY ON TRANSURETHRAL RESECTION OF THE PROSTATE (TURP): TWO DECADES OF CHANGE Jason Izard and J. Curtis Nickel Jason IzardJason Izard More articles by this author and J. Curtis NickelJ. Curtis Nickel More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.2147AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The introduction of medical therapy for symptomatic benign prostatic hyperplasia (BPH) may have shifted the indications, patient characteristics and outcomes in men undergoing TURP over the last two decades (1988 to 2008). METHODS All patients who underwent TURP for symptomatic BPH in a geographically defined area at our Institution in 1998 (before general introduction of medical therapy for BPH), 1998 (when medical therapy was becoming an important therapy for BPH), and 2008 (medical therapy was the primary initial therapy for BPH) were reviewed. We assessed total number of TURPs, indications for surgery, patient age, health status, weight of resected tissue, and pre- and post-operative complications. RESULTS There was a 60% decrease in TURPs from 1988 (n = 157) to 1998 with a moderate increase in number in 2008. Failure of medical therapy was not an indication in 1988 but was at least one of the indications for TURP in 36% and 83% in 1998 and 2009 respectively. No significant differences were found in age, co-morbid status or resected prostate weight between the 3 groups. There was a significant rise in patients presenting with acute (AUR) and/or chronic (CUR) (greater than 300 cc residual) urinary retention at the time of their TURP (for AUR 22.9%, 54.&% and 42.9% and for CUR 14.6%, 20.3% and 39.3% in 1988, 1998 and 2008 respectively), but fewer patients presented with hydronephrosis in 2008 (7.1%) compared to 1998 (12.5%) but this was still much higher than in 1988 (1.3%). Post-operative days in hospital decreased over the decades (from 4.1 days in 1988 to 2.7 in 1998 and then to 2.1 days in 2008), however, the number of patients discharged with a catheter (failure to void) increased over 2 decades (from 3.2% to 12.5% to 28.6% respectively). CONCLUSIONS The dramatic decrease in the number of TURPs performed for symptomatic BPH at our Institution since the introduction of medical therapy has now leveled off. However, the proportion of TURP patients presenting with urinary retention and the number being discharged with a catheter after a failed trial of voiding has increased. This would suggest that although the average age and medical co-morbidities of our TURP patients has not dramatically changed, patients currently presenting for TURP appear to have experienced more pre-TURP progression and poorer immediate outcomes over the decades from 1988 to 2008. Could this be a direct result of increasing reliance on medical therapy? Kingston, Canada© 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e811 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jason Izard More articles by this author J. Curtis Nickel More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

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