Prostatic surgery for benign prostatic hyperplasia: meeting the expanding demand

We describe changes in the pattern of surgery for benign prostatic hyperplasia (BPH) in Scotland between 1971 and 1989. The data are based on an analysis of routinely collected Scottish hospital in-patient statistics for primary prostatic operations on men with a diagnosis of BPH (ICD Code 600.0). Primary operation age-adjusted rates for BPH increased from 8.9 to 15.8 per 10,000 male population from 1971 to 1989. This was accompanied by a reduction in bed day use for BPH surgery from 49,500 bed days in 1971 to 36,000 in 1989. Case fatality for all surgery for BPH also fell steadily and can no longer be regarded as a relevant measure of prostatectomy outcome. Virtually all surgical intervention is now transurethral resection (TUR), forming 94% of surgery for BPH in 1989 compared with only 32% in 1971. The increase in surgical procedures carried out for BPH has been greater in younger age groups. If the pattern of increasing surgical intervention in the management of BPH over the past few years continues and there is an increased demand for treatment, and if the reported demographic changes occur, there will be a need for an additional 9 new consultant urologists in Scotland by 2001. Even if present operation rates hold steady, population changes alone will produce enough work for 2 more urologists.