Case-fatality of hyperplasia of the prostate in two teaching and three regional-board hospitals

Mortality of hyperplasia of the prostate, as in many common conditions, is higher in the regional board than the teaching hospitals of England and Wales. 932 men with simple hyperplasia of the prostate consecutively admitted to two teaching and three regional-board hospitals have been studied. There were 5 deaths among 556 men admitted from the waiting-list, and negligible variation between hospitals. Among the 376 unplanned emergency admissions were 35 deaths, 26 of them in 71 men who did not have prostatectomy. Unplanned admissions, especially those not operated on, were older than the rest and mostly in acute retention, and many also had cardiovascular and other disease. 78% of the admissions to two of the regional-board hospitals were unplanned; the operation-rate on these men was generally low and case-fatality among them was 14%. In contrast, only 22% of the admissions to the two teaching hospitals were unplanned, nearly every case was operated on, and the case-fatality was 4.3%. These two regional-board hospitals with relatively small resources were carrying more than their share of the most difficult cases. A national survey to assess the treatment of hyperplasia of the prostate is now indicated, but it is time the National Health Service gathered this kind of information routinely.