The Effect of TURP on Symptom Severity and Quality of Life

M. Emberton, et al. BJU, (1996) 77, P. 233-247.

Emberton and colleagues performed a prospective, cohort study in the UK of 5276 men receiving a prostatectomy from 101 surgeons during a 6-month period. Using the AUA symptom and bother scores, disease specific and generic QOL scores, along with occurrences of adverse events and 3 global questions on the results of their treatment at 3 months post surgery, this study concluded prostatectomy is effective in reducing symptoms in most men. The details of the study are especially interesting. Patients were required to recall their pre-operative symptom information and record it at the same time they recorded their 3-month post-operative symptoms. The best improvements came for younger men and men with more severe symptoms. The type of surgery, the surgeon, the weight of tissue resected, post-void residuals and maximum urine flow were not associated with symptom improvement. Patients with irritative symptoms benefited more than those with obstructive symptoms.

Adverse events included impotence, incontinence and retrograde ejaculation. Of 1339 men who had no erectile difficulty pre-operatively, 31% experienced problems at 3 months post-treatment. Some pre-treatment incontinent patients had an improvement in their continence post-treatment, but of men who were totally dry pre-treatment, 33% were incontinent 3 months post-treatment. Retrograde ejaculation was reported by 67% of patients following prostatectomy. An interesting note for the current American debate about changing the U.S. healthcare system: in this study, sociodemographic factors were associated with pre-operative symptom severity. Men aged less than 70 years, men receiving private-pay care, men with tertiary education and men of a higher social class all had significantly lower pre-operative symptom scores. And finally, Emberton writes, "This question (of whether poor results were related to lack of pre-treatment obstruction) is unlikely to be resolved until a non-invasive and cheap method of measuring outflow tract obstruction becomes available." Will further studies determine The Spanner Prostatic Stent can allow the patient to experience life de-obstructed to simulate surgery?

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