Transurethral Resection of the Prostate for Benign Prostatic Obstruction: Will It Remain the Gold Standard?
2014; Elsevier BV; Volume: 67; Issue: 6 Linguagem: Inglês
10.1016/j.eururo.2014.12.022
ISSN1873-7560
Autores Tópico(s)Pelvic floor disorders treatments
ResumoIn the United Kingdom, symptomatic benign prostatic obstruction (BPO) affects 2.5 million men, with 44 000 new cases diagnosed annually. Symptomatic BPO is associated with worsening physical role, social functioning, vitality, and mental health [1]. The number of patients with BPO is expected to grow by almost 50% by the year 2025, as it is a disease of older men [2]. Men usually present with lower urinary tract symptoms (LUTS), such as slow and intermittent urinary stream, or with acute urinary retention (AUR). LUTS may be treated by watchful waiting or drugs, but many will require prostate surgery. About 25 000 procedures are currently performed annually in the United Kingdom, accounting for an expenditure of about £54million per year. Transurethral resection of the prostate (TURP) has been the gold standard operation for LUTS and AUR and has not changed significantly in 30 yr. TURP is associatedwith a small but significant risk, with a 30-d mortality of 0.3% and a variety of morbidities including transurethral resection syndrome (1%), which is the absorption of irrigating fluid leading to confusion and collapse, haemorrhage during the operation (transfusion rate: 5%), and subsequent urinary tract infections (20%) [3]. These morbidities result in delayed discharge, increased readmissions, and increased primary care utilisation, causing considerable distress to patients and resulting in additional costs for the UK National Health Service (NHS), or any health service around the world. Because the operation is increasingly performed on older men—in the NHS, for example, 41% of the TURP operations in 2010– 2011 were on patients >75 yr—the risks of surgery will likely increase as the population ages. According to theNHS hospital episode statistics, themedian stay in hospital after
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