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Surgical Outcomes for Elderly Patients Undergoing Transurethral Resection of the Prostate for Chronic Urinary
Vaki Antoniou1, Faisal Edris1, Winnette Akpobire1
1Urology Department, University Hospital Southampton, Southampton, United Kingdom.
Insights
Transurethral resection of the prostate (TURP) offers high success rates for catheterized elderly patients with chronic urinary retention (CUR). Selected patients achieved an 88.8% catheter-free rate at 12 months, demonstrating TURP
Area of Science:
- Urology
- Geriatric Medicine
- Surgical Outcomes
Background:
- Chronic urinary retention (CUR) significantly impacts elderly patients' quality of life and health.
- Transurethral resection of the prostate (TURP) is a treatment option, but often avoided in elderly due to risks and detrusor underactivity.
- Contemporary outcomes for catheterized elderly patients undergoing TURP are not well-documented.
Purpose of the Study:
- To evaluate the outcomes of TURP in elderly patients (≥80 years) with CUR requiring catheterization.
- To identify risk factors for surgical failure in this patient population.
- To assess the complication rates associated with TURP in elderly patients.
Main Methods:
- Retrospective review of 147 catheterized patients aged 80+ undergoing TURP for CUR between 2012-2020.
- Exclusion criteria included neurogenic bladder, urethral stricture, or prior TURP.
- Surgical success defined as being catheter-free at 3 and 12 months; statistical analysis via Chi-squared and logistic regression.
Main Results:
- 80.3% of patients were catheter-free at 3 months, and 79.6% at 12 months.
- Independent risk factors for failure included pre-TURP postvoid residual >1500 mL, age ≥90, and WHO performance status ≥3.
- A selected subset excluding these factors achieved an 88.8% catheter-free rate at 3 months.
- Overall complication rate was 9.5% (6.8% early, 2.7% late).
Conclusions:
- TURP is an effective treatment for selected elderly patients with CUR, achieving high catheter-free rates.
- Careful patient selection based on identified risk factors can optimize outcomes.
- The benefits of TURP may outweigh the risks compared to long-term catheterization in this population.
Abstract:
Chronic urinary retention (CUR) is a major problem in elderly patients and leads to high levels of morbidity. CUR can be treated surgically with transurethral resection of the prostate (TURP), but surgery is frequently avoided in elderly patients due to increased perioperative risks and the presence of detrusor underactivity, which can lead to surgical failure. We report on contemporary outcomes for catheterized elderly patients undergoing TURP from a high-volume university teaching hospital. Catheterized patients 80 years of age and older undergoing TURP for CUR at a university teaching hospital between 2012 and 2020 (9 years) were eligible. Those with neurogenic bladder, urethral stricture, or prior TURP were excluded. Surgical success was defined as being catheter free at 3- and 12-month follow-up. Statistical analysis was performed using the Chi-squared test for grouped data and logistic regression modeling for continuous data. A total of 147 patients were included and underwent TURP. Of these, 118 (80.3%) were completely catheter free or using intermittent self-catheterization at initial 3-month follow-up. One hundred seventeen (79.6%) remained catheter free at 1-year follow-up. Postvoid residual >1500 mL before TURP (p = 0.017); age ≥90 (p = 0.0067); and World Health Organization performance status ≥3 (p < 0.00001) were all identified as independent risk factors for surgical failure. A selected subset of patients excluding these risk factors showed overall catheter-free rates of 88.8% at 3-month follow-up. Early and late complications were noted in 6.8% and 2.7% of patients. Our contemporary series demonstrate high rates of successful postoperative voiding for selected elderly patients after TURP, with catheter-free rates at 12 months of 88.8%. Overall complication rate was 9.5%, which may be justified given the alternative morbidity of long-term catheterization. TURP remains an efficacious and cost-effective treatment for selected elderly patients who are catheterized for CUR.
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