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OUTCOME AFTER SURGERY FOR BENIGN PROSTATIC HYPERTROPHY.

The standard approach to treating benign prostatic hypertrophy is transurethral resection of the prostate (TURP), despite the absence of careful evaluation of this therapy in comparison with other treatments. These investigators, however, raise some doubts about the wisdom of this standard. They evaluated data from more than 54,000 men from Denmark, England, and Canada who had undergone TURP or open prostatectomy with up to eight years of follow-up. The two groups were compared with respect to overall mortality and the need for a second operation.

Irrespective of the duration of follow-up or the country of origin, men who had a TURP were significantly more likely to require a repeat procedure. After eight years, the likelihood of a second procedure for men who had a TURP, depending on the country, ranged from 2.7 to 6.7 times greater than the risk for men who had an open prostatectomy. In addition, men who had a TURP had a significantly higher mortality rate at the end of the follow-up period. Even after adjustment for age, other diagnoses, and medications, the long-term mortality rate for TURP patients was about 1.5 times that for open-prostatectomy patients.

Because these data are retrospective, the mortality differences may be explained by selection biases. The authors recommend a randomized trial of TURP versus open prostatectomy, a sentiment echoed by Greenfield in an accompanying editorial.

— KIM

Published in Journal Watch General Medicine May 5, 1989

Citation(s):

Greenfield S. The state of outcome research: are we on target?. N Engl J Med 1989 Apr 27 320 1142-1143.

• Medline abstract (Free)

Roos NP et al. Mortality and reoperation after open and transurethral resection of the prostate for benign prostatic hyperplasia. N Engl J Med 1989 Apr 27 320 1120-1124.

• Medline abstract (Free)

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