The effect of prostatectomy on symptom severity and quality of life

Emberton, Mark; Neal, David E.; Black, Nick; Fordham, M.V.P.; Harrison, Michael; McBrien, M. P.; Williams, RE; McPherson, Klim; Devlin, H Brendan

doi:10.1046/j.1464-410x.1996.88213.x

Cited by 137 publications

(78 citation statements)

References 7 publications

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“…In a large study by Emberton et al [2] of > 3000 patients treated by TURP the AUA score decreased from a mean of 20.1 at baseline to 7.4 at 3 months. In a randomized study of ILC and TURP by Muschter et al [11], although only published as an abstract to date, the results were excellent in both groups at 12 months (AUA scores of 3.5 and 2.3).…”

Section: Discussionmentioning

confidence: 94%

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Transurethral interstitial laser coagulation of the prostate and transurethral microwave thermotherapy vs transurethral resection or incision of the prostate: results of a randomized, controlled study in patients with symptomatic benign prostatic hyperplasia

2002

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Objective To compare the efficacy and frequency of complications of transurethral interstitial laser coagulation (ILC) and transurethral microwave thermotherapy (TUMT) with transurethral resection or incision of the prostate (TURP/TUIP) in patients with symptomatic benign prostatic hyperplasia (BPH). Patients and methods Forty-eight patients were randomized to undergo ILC, 46 to TUMT and 24 to TURP/ TUIP; they were followed for 6 months and the outcome analysed on an intention-to-treat basis. Results At 6 months the symptom scores and maximum urinary flow rate (Q max ) had improved significantly in all groups. At 6 months the mean symptom score was 9.2 in both experimental groups and 6.8 in the control group ( P > 0.05); the mean Q max was 20.6 mL/s in the control group, 16.2 in the ILC group ( P > 0.05 vs control) and 13.2 in the TUMT group ( P < 0.05 vs. the control group). In the TUMT group patients developing urinary retention afterward had a significantly greater increase in Q max than those who did not. The types of complications in the three groups varied. Urinary tract infection occurred frequently in the experimental groups, especially after ILC, whereas the 'well-known' complications of TURP occurred in the control group.Overall, 36% in the ILC, 54% in the TUMT and 73% in the control group had no complications (retrograde ejaculation excluded) during the first 6 months. One patient in the TUMT group underwent TURP after 3 months, whereas no patients in the ILC or the control group were re-treated for BPH within the first 6 months. Conclusion In the short term both ILC and TUMT are reasonable alternatives to standard transurethral surgery for symptomatic BPH, where the reduction of symptoms is the primary goal of treatment. However, both ILC and TUMT were associated with morbidity, although the complication profiles differed from those after TURP/TUIP. Both ILC and TUMT seem advantageous in some patients because of the reduced risk of bleeding and the eliminated risk of TUR syndrome, and because TUMT only requires local anaesthesia. Thus, as neither treatment is better in all aspects, the advantages of one technique over the other must be weighed when deciding how to treat each patient.

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Section: Discussionmentioning

confidence: 94%

“…For many years TURP has been the standard treatment for the patient with symptoms which are too bothersome. TURP is effective but carries a risk of significant complications [2]. Consequently much effort has been devoted to developing new pharmaceutical and interventional treatments that have minimal risks and acceptable effectiveness.…”

Section: Introductionmentioning

confidence: 99%

Transurethral interstitial laser coagulation of the prostate and transurethral microwave thermotherapy vs transurethral resection or incision of the prostate: results of a randomized, controlled study in patients with symptomatic benign prostatic hyperplasia

2002

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“…The overall rate of response of 85.9% was encouraging and the percentage of patients agreeing to some form of assessment (66.8%) compares favourably with similar registers 12 and large audit studies. 13 The ONS tracing service was essential for the follow-up of the remaining patients, informing as to whether they were still alive and the name of each patient's general practitioner via the FHSA. These gave us vital clinical details and the current addresses of the patients, but it is interesting to note that only 23% of those known to be alive, responded to the further contact letter.…”

Section: Discussionmentioning

confidence: 99%

The Trent regional arthroplasty study

Fender

Harper

Gregg

2000

The Journal of Bone and Joint Surgery. British volume

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W e have assessed the usefulness of a regional hip register in the assessment of the outcome of primary total hip replacement (THR). Over 97% of THRs performed in the Trent region in 1990 were captured onto the register and the inaccuracies recorded were less than 1.8%. In an independent assessment of 2111 patients five years after THR, 85.9% of those available for assessment responded, and 66.8% agreed to an assessment.The cost of this independent assessment at five years, utilising a regional hip register, was approximately £50 per implant. This is a reasonable outlay to identify problems early. Some form of registration and outcome assessment should be performed on a national level.

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“…2 A report by Schou et al 27 found that, among the 54% of men with clinically significant LUTS (as measured by the DAN-PSS questionnaire) who had reduced ejaculatory volume, the related bother factor was minimal. Indeed, Emberton et al 28 have demonstrated a minimal effect of ejaculatory dysfunction on quality of life even after transurethral resection of the prostate, which carries a much higher risk for retrograde ejaculation than does medical management. In both of these studies, though, the mean age of the population was higher than in the randomized clinical trials for the a-blockers, which may explain the relatively low bother score for ejaculatory dysfunction in these settings.…”

Section: Sexual Dysfunctionmentioning

confidence: 99%

Medical therapy for benign prostatic hyperplasia: sexual dysfunction and impact on quality of life

Carbone

Hodges

2003

Int J Impot Res

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Therapies for benign prostatic hyperplasia (BPH) may either improve or exacerbate sexual function with an ensuing impact on quality of life. Here we review a total of 73 papers on medical therapies for BPH with a focus on the effects of different pharmacological agents on sexual function. For example, certain a 1 -adrenergic receptor blockers may improve erectile function; however, ejaculatory dysfunction with one of these agents, tamsulosin, occurs at a rate of 4-18%, rising to 30% with long-term use. In addition, treatment with the 5a-reductase inhibitor finasteride is associated with problems of ejaculation (2.1-7.7%), erection (4.9-15.8%), and libido (3.1-5.4%). Such significant and undesirable complications in relation to sexual function produce a welldocumented negative impact on quality of life. Thus, optimal treatment for men with BPH requires the use of agents that demonstrate efficacy and safety with fewer sexual side effects.

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The effect of prostatectomy on symptom severity and quality of life

Abstract: Prostatectomy is effective in reducing symptoms in most men. Men who experience a substantial reduction in symptoms were more likely to report a favourable outcome. The study confirmed that approximately one-third of men reported an unfavourable result 3 months after their operation.

Cited by 137 publications

References 7 publications

Transurethral interstitial laser coagulation of the prostate and transurethral microwave thermotherapy vs transurethral resection or incision of the prostate: results of a randomized, controlled study in patients with symptomatic benign prostatic hyperplasia

Transurethral interstitial laser coagulation of the prostate and transurethral microwave thermotherapy vs transurethral resection or incision of the prostate: results of a randomized, controlled study in patients with symptomatic benign prostatic hyperplasia

The Trent regional arthroplasty study

Medical therapy for benign prostatic hyperplasia: sexual dysfunction and impact on quality of life

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