Introduction and Objectives: The introduction of medical therapy forsymptomatic benign prostatic hyperplasia (BPH) during the last 2 decadesmay have shifted the indications, patient characteristics and outcomes inmen undergoing TURP over the last 2 decades (1988 to 2008).Methods: All patients who underwent TURP for symptomatic BPH in ageographically defined area at our Institution in 1998 (before generalintroduction of medical therapy for BPH), 1998 (when medical therapywas becoming an important therapy for BPH), and 2008 (medical therapywas the primary initial therapy for BPH) were reviewed. We assessedtotal number of TURPs, indications for surgery, patient age, health status,weight of resected tissue, and pre- and postoperative complications.Results: There was a 60% decrease in TURPs from 1988 (n = 157) to 1998with a moderate increase in number in 2008. Failure of medical therapywas not an indication in 1988 but was at least one of the indications forTURP in 36% and 87% in 1998 and 2008 respectively. No significantdifferences were found in age. There was a significant rise in patients presentingwith chronic urinary retention at the time of their TURP (15% in1988, 20% in 1998 and 39% in 2008), but fewer patients presented withhydronephrosis in 2008 (7.1%) compared to 1998 (12.5%) but this wasstill much higher than in 1988 (1.3%). Postoperative days in hospitaldecreased over the decades (from 4.1 days in 1988 to 2.7 in 1998 andthen to 2.1 days in 2008); however, the number of patients dischargedwith a catheter (failure to void) increased over 2 decades (from 3.2% to12.5% to 28.6% respectively).Conclusions: The dramatic decrease in the number of TURPs performedfor symptomatic BPH at our Institution since the advent of medical therapyhas now leveled off. However, the proportion of TURP patients presentingwith urinary retention and the number being discharged with acatheter after a failed trial of voiding has increased. This would suggestthat although the average age and medical co-morbidities of our TURPpatients has not dramatically changed, patients currently presenting forTURP appear to have experienced more pre-TURP progression and poorerimmediate outcomes over the decades from 1988 to 2008. Could this bea direct result of increasing reliance on medical therapy?.
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