- Email: [email protected]
2086 IMPACT OF MEDICAL THERAPY ON TRANSURETHRAL RESECTION OF THE PROSTATE (TURP): TWO DECADES OF CHANGE
Vol. 183, No. 4, Supplement, Wednesday, June 2, 2010
THE JOURNAL OF UROLOGY姞
(65.8%) who were sexually active pre-operatively completed the SQ follow-up reporting that they were all (100%) sexually active. 20 of the 160 (12.5%) men with pre-existing sexual dysfunction reported improved sexual activity and erection quality. At 6 years, 101 completed the SQ of which 39 (38.6%) were sexually active. At 12 years, 113 completed the SQ of which 42 (37%) were sexually active. Of the 79 patients who completed the 6 months follow-up, 47 (mean age 64) completed the 12 years follow up. Of these, 30 (64%) were still sexually active. These results were corroborated by the partners (Table) CONCLUSIONS: Erectile difficulties frequently precede TURP. Pre-operative sexual dysfunction can be improved by TURP. Longterm sexual function continues to be maintained following TURP. These findings were corroborated by the partners. However, on occasions, discrepancy between the patient and partner was difficult to explain. [* partner or spouse] Table Patient and spouse response regarding sexual status Spouse agrees Sexually active / spouse response Pre TURP n ⫽ 54 (81.8%) n ⫽ 66 Sexually active Spouse differs [No spouse or no response ⫽ 54] n ⫽ 120 12 (18.2%) Pre TURP Sexually inactive n ⫽ 160
Sexually inactive / spouse response n ⫽ 78 [No spouse or no response ⫽ 82]
Spouse agrees n ⫽ 75 (96.2%) Spouse differs n ⫽ 3 (3.8%)
6 Months Sexually active n ⫽ 79
Sexually active / spouse response n ⫽ 36 [No spouse or no response ⫽ 43]
Spouse agrees n ⫽ 31 (86%) Spouse differs n ⫽ 5 (14%)
6 Months Sexually inactive n ⫽ 71
Sexually inactive / spouse response n ⫽ 31 [No spouse or no response ⫽ 40]
Spouse agrees n ⫽ 30 (96.8%) Spouse differs n ⫽ 1 (3.2%)
6 Years Sexually active n ⫽ 39
Sexually active / spouse response n ⫽ 22 [No spouse or no response ⫽ 7]
Spouse agrees n ⫽ 17 (77.3%) Spouse differs n ⫽ 5 (22.7%)
6 Years Sexually inactive n ⫽ 62
Sexually inactive / spouse response n ⫽ 36 [No spouse or no response ⫽ 34]
Spouse agrees n ⫽ 34 (94.4%) Spouse differs n ⫽ 2 (5.6%)
12 Years Sexually active n ⫽ 42
Sexually active / spouse response n ⫽ 21 [No spouse or no response ⫽ 4]
Spouse agrees n ⫽ 19 (90.5%) Spouse differs n ⫽ 2 (9.5%)
12 Years Sexually inactive n ⫽ 71
Sexually inactive / spouse response n ⫽ 39 [No spouse or no response ⫽ 36]
Spouse agrees n ⫽ 38 (97.4%) Spouse agrees n ⫽ 1 (2.6%)
Source of Funding: None
2086 IMPACT OF MEDICAL THERAPY ON TRANSURETHRAL RESECTION OF THE PROSTATE (TURP): TWO DECADES OF CHANGE Jason Izard*, J. Curtis Nickel, Kingston, Canada INTRODUCTION AND OBJECTIVES: The introduction of medical therapy for symptomatic benign prostatic hyperplasia (BPH) may have shifted the indications, patient characteristics and outcomes in men undergoing TURP over the last two decades (1988 to 2008). METHODS: All patients who underwent TURP for symptomatic BPH in a geographically defined area at our Institution in 1998 (before general introduction of medical therapy for BPH), 1998 (when medical therapy was becoming an important therapy for BPH), and 2008 (medical therapy was the primary initial therapy for BPH) were reviewed. We assessed total number of TURPs, indications for surgery, patient age, health status, weight of resected tissue, and pre- and post-operative complications. RESULTS: There was a 60% decrease in TURPs from 1988 (n ⫽ 157) to 1998 with a moderate increase in number in 2008. Failure of medical therapy was not an indication in 1988 but was at least one of the indications for TURP in 36% and 83% in 1998 and 2009 respec-
e811
tively. No significant differences were found in age, co-morbid status or resected prostate weight between the 3 groups. There was a significant rise in patients presenting with acute (AUR) and/or chronic (CUR) (greater than 300 cc residual) urinary retention at the time of their TURP (for AUR 22.9%, 54.&% and 42.9% and for CUR 14.6%, 20.3% and 39.3% in 1988, 1998 and 2008 respectively), but fewer patients presented with hydronephrosis in 2008 (7.1%) compared to 1998 (12.5%) but this was still much higher than in 1988 (1.3%). Postoperative days in hospital decreased over the decades (from 4.1 days in 1988 to 2.7 in 1998 and then to 2.1 days in 2008), however, the number of patients discharged with a catheter (failure to void) increased over 2 decades (from 3.2% to 12.5% to 28.6% respectively). CONCLUSIONS: The dramatic decrease in the number of TURPs performed for symptomatic BPH at our Institution since the introduction of medical therapy has now leveled off. However, the proportion of TURP patients presenting with urinary retention and the number being discharged with a catheter after a failed trial of voiding has increased. This would suggest that although the average age and medical co-morbidities of our TURP patients has not dramatically changed, patients currently presenting for TURP appear to have experienced more pre-TURP progression and poorer immediate outcomes over the decades from 1988 to 2008. Could this be a direct result of increasing reliance on medical therapy? Source of Funding: None
2087 COST ANALYSIS OF VARIOUS PROCEDURES FOR SURGICAL MANAGEMENT OF BENIGN ENLARGEMENT OF PROSTATE. Narmada Gupta*, Nitin Abrol, New Delhi, India INTRODUCTION AND OBJECTIVES: In this era of rapidly rising cost of health care due to application of newer technology, cost analysis has become a matter of great concern. We analysed the cost of various surgical procedures for management of benign enlargement of prostate (BEP). METHODS: We considered manpower cost, cost of surgical and Operation theatre equipment, cost of post operative ward stay for estimation of direct cost of each procedure. Cost of manpower and equipments in operation theatre for each case was calculated from per minute cost and mean operative time for that case. Cost of surgical equipment per case was estimated from yearly cost and assuming that 100 cases are done in one year. RESULTS: Total 977 patients underwent surgical management of BEP from January 2003 to October 2009. Monopolar Transurethral Resection of Prostate (TURP) was done in 584, Monopolar Transurethral Vapour Resection of Prostate (TUVRP) in 259, Bipolar TURP in 39, Holmium Laser Enucleation of Prostate (HOLEP) in 79 and Photoselective Vaporization of Prostate (PVP) was done in 16 patients. Manpower cost and OT equipment cost was maximum for HOLEP (133.26 and 9.14 US Dollars respectively). Cost of surgical equipment was highest for PVP group. Overall cost per case for Monopolar TURP, Monopolar TUVRP, Bipolar TURP, HOLEP, PVP was 169.77, 157.6, 240.42, 399.07 and 2043.95 US Dollars respectively. CONCLUSIONS: We conclude that TURP with modifications is still gold standard for its cost effectiveness. Cost of initial installation of surgical equipment and disposables contribute most to the overall cost of the procedure. Cost of hospital stay may be variable in different countries and may influence choice of the surgeon for a particular procedure.
THE JOURNAL OF UROLOGY姞
(65.8%) who were sexually active pre-operatively completed the SQ follow-up reporting that they were all (100%) sexually active. 20 of the 160 (12.5%) men with pre-existing sexual dysfunction reported improved sexual activity and erection quality. At 6 years, 101 completed the SQ of which 39 (38.6%) were sexually active. At 12 years, 113 completed the SQ of which 42 (37%) were sexually active. Of the 79 patients who completed the 6 months follow-up, 47 (mean age 64) completed the 12 years follow up. Of these, 30 (64%) were still sexually active. These results were corroborated by the partners (Table) CONCLUSIONS: Erectile difficulties frequently precede TURP. Pre-operative sexual dysfunction can be improved by TURP. Longterm sexual function continues to be maintained following TURP. These findings were corroborated by the partners. However, on occasions, discrepancy between the patient and partner was difficult to explain. [* partner or spouse] Table Patient and spouse response regarding sexual status Spouse agrees Sexually active / spouse response Pre TURP n ⫽ 54 (81.8%) n ⫽ 66 Sexually active Spouse differs [No spouse or no response ⫽ 54] n ⫽ 120 12 (18.2%) Pre TURP Sexually inactive n ⫽ 160
Sexually inactive / spouse response n ⫽ 78 [No spouse or no response ⫽ 82]
Spouse agrees n ⫽ 75 (96.2%) Spouse differs n ⫽ 3 (3.8%)
6 Months Sexually active n ⫽ 79
Sexually active / spouse response n ⫽ 36 [No spouse or no response ⫽ 43]
Spouse agrees n ⫽ 31 (86%) Spouse differs n ⫽ 5 (14%)
6 Months Sexually inactive n ⫽ 71
Sexually inactive / spouse response n ⫽ 31 [No spouse or no response ⫽ 40]
Spouse agrees n ⫽ 30 (96.8%) Spouse differs n ⫽ 1 (3.2%)
6 Years Sexually active n ⫽ 39
Sexually active / spouse response n ⫽ 22 [No spouse or no response ⫽ 7]
Spouse agrees n ⫽ 17 (77.3%) Spouse differs n ⫽ 5 (22.7%)
6 Years Sexually inactive n ⫽ 62
Sexually inactive / spouse response n ⫽ 36 [No spouse or no response ⫽ 34]
Spouse agrees n ⫽ 34 (94.4%) Spouse differs n ⫽ 2 (5.6%)
12 Years Sexually active n ⫽ 42
Sexually active / spouse response n ⫽ 21 [No spouse or no response ⫽ 4]
Spouse agrees n ⫽ 19 (90.5%) Spouse differs n ⫽ 2 (9.5%)
12 Years Sexually inactive n ⫽ 71
Sexually inactive / spouse response n ⫽ 39 [No spouse or no response ⫽ 36]
Spouse agrees n ⫽ 38 (97.4%) Spouse agrees n ⫽ 1 (2.6%)
Source of Funding: None
2086 IMPACT OF MEDICAL THERAPY ON TRANSURETHRAL RESECTION OF THE PROSTATE (TURP): TWO DECADES OF CHANGE Jason Izard*, J. Curtis Nickel, Kingston, Canada INTRODUCTION AND OBJECTIVES: The introduction of medical therapy for symptomatic benign prostatic hyperplasia (BPH) may have shifted the indications, patient characteristics and outcomes in men undergoing TURP over the last two decades (1988 to 2008). METHODS: All patients who underwent TURP for symptomatic BPH in a geographically defined area at our Institution in 1998 (before general introduction of medical therapy for BPH), 1998 (when medical therapy was becoming an important therapy for BPH), and 2008 (medical therapy was the primary initial therapy for BPH) were reviewed. We assessed total number of TURPs, indications for surgery, patient age, health status, weight of resected tissue, and pre- and post-operative complications. RESULTS: There was a 60% decrease in TURPs from 1988 (n ⫽ 157) to 1998 with a moderate increase in number in 2008. Failure of medical therapy was not an indication in 1988 but was at least one of the indications for TURP in 36% and 83% in 1998 and 2009 respec-
e811
tively. No significant differences were found in age, co-morbid status or resected prostate weight between the 3 groups. There was a significant rise in patients presenting with acute (AUR) and/or chronic (CUR) (greater than 300 cc residual) urinary retention at the time of their TURP (for AUR 22.9%, 54.&% and 42.9% and for CUR 14.6%, 20.3% and 39.3% in 1988, 1998 and 2008 respectively), but fewer patients presented with hydronephrosis in 2008 (7.1%) compared to 1998 (12.5%) but this was still much higher than in 1988 (1.3%). Postoperative days in hospital decreased over the decades (from 4.1 days in 1988 to 2.7 in 1998 and then to 2.1 days in 2008), however, the number of patients discharged with a catheter (failure to void) increased over 2 decades (from 3.2% to 12.5% to 28.6% respectively). CONCLUSIONS: The dramatic decrease in the number of TURPs performed for symptomatic BPH at our Institution since the introduction of medical therapy has now leveled off. However, the proportion of TURP patients presenting with urinary retention and the number being discharged with a catheter after a failed trial of voiding has increased. This would suggest that although the average age and medical co-morbidities of our TURP patients has not dramatically changed, patients currently presenting for TURP appear to have experienced more pre-TURP progression and poorer immediate outcomes over the decades from 1988 to 2008. Could this be a direct result of increasing reliance on medical therapy? Source of Funding: None
2087 COST ANALYSIS OF VARIOUS PROCEDURES FOR SURGICAL MANAGEMENT OF BENIGN ENLARGEMENT OF PROSTATE. Narmada Gupta*, Nitin Abrol, New Delhi, India INTRODUCTION AND OBJECTIVES: In this era of rapidly rising cost of health care due to application of newer technology, cost analysis has become a matter of great concern. We analysed the cost of various surgical procedures for management of benign enlargement of prostate (BEP). METHODS: We considered manpower cost, cost of surgical and Operation theatre equipment, cost of post operative ward stay for estimation of direct cost of each procedure. Cost of manpower and equipments in operation theatre for each case was calculated from per minute cost and mean operative time for that case. Cost of surgical equipment per case was estimated from yearly cost and assuming that 100 cases are done in one year. RESULTS: Total 977 patients underwent surgical management of BEP from January 2003 to October 2009. Monopolar Transurethral Resection of Prostate (TURP) was done in 584, Monopolar Transurethral Vapour Resection of Prostate (TUVRP) in 259, Bipolar TURP in 39, Holmium Laser Enucleation of Prostate (HOLEP) in 79 and Photoselective Vaporization of Prostate (PVP) was done in 16 patients. Manpower cost and OT equipment cost was maximum for HOLEP (133.26 and 9.14 US Dollars respectively). Cost of surgical equipment was highest for PVP group. Overall cost per case for Monopolar TURP, Monopolar TUVRP, Bipolar TURP, HOLEP, PVP was 169.77, 157.6, 240.42, 399.07 and 2043.95 US Dollars respectively. CONCLUSIONS: We conclude that TURP with modifications is still gold standard for its cost effectiveness. Cost of initial installation of surgical equipment and disposables contribute most to the overall cost of the procedure. Cost of hospital stay may be variable in different countries and may influence choice of the surgeon for a particular procedure.