Transurethral resection of the prostate for benign prostatic hypertrophy: factors associated with a successful outcome at 1 year

To investigate which patient and health service factors are predictive of outcome following transurethral resection for benign prostatic hypertrophy.

A total of 388 men were assessed before and 3, 6 and 12 months following surgery. Twenty-one patient characteristics and 12 health service factors were considered. Successful outcome was assessed in terms of avoidance of adverse effects of the operation (survival, lack of early complications and later problems) and improvement in symptoms, health status (assessed in three ways) and quality of life. An overall assessment based on all eight outcome measures was also used. Relationships between possible predictors and outcome were explored whilst controlling for three potential confounders: age, diagnostic category and co-morbidity. A linear logistic model was employed.

Patients who had severe pre-operative symptoms but who otherwise enjoyed good health gained the most benefit from surgery. Generally speaking, outcome was not associated with any of the 12 health service factors studied.

The results support the policy of watchful waiting for mild or moderately symptomatic patients as even if surgery becomes necessary because of a deterioration in the condition, the benefit resulting will be greater. However, any benefits of waiting for surgery would have to be balanced against any increase in urinary tract pathology or co-morbidity that men may suffer whilst waiting, as these will increase the likelihood of an adverse outcome of surgery. The question of whether to wait or not will only finally be resolved by means of a randomized controlled trial comparing transurethral resection of the prostate with watchful waiting.