Outcome of transurethral prostatectomy for the palliative management of lower urinary tract symptoms in men with prostate cancer.
OBJECTIVE
To investigate the efficacy of palliative transurethral prostatectomy (TURP) for lower urinary tract symptoms (LUTS) in men with prostate cancer.


METHODS
The surgical outcome of TURP performed in 46 men with prostate cancer was studied. A poor outcome was defined as the development of urinary incontinence, repeat surgery and placement of a long-term catheter (LTC) within 1 year of surgery. A cohort of 47 men who underwent TURP for benign prostatic hyperplasia (BPH) was used as a control population.


RESULTS
Initial catheter removal failed in a larger number of cancer patients compared to men with BPH (43% and 10%, respectively, P = 0.0001). Using objective endpoints, 37% (17/46) of cancer patients were defined as having a poor outcome because of repeat surgery, placement of a LTC or urinary incontinence following TURP. These events occurred in only 12% (6/47) of the control cohort (P = 0.004). In multiple regression analysis a good outcome was associated with presentation in acute urinary retention (AUR; P = 0.01) while a poor outcome was associated with surgery in the context of hormone refractory disease (P = 0.004). Requirement for a LTC despite surgery (12/46) was also associated with the absence of AUR at presentation (P = 0.01) and hormone refractory disease (P = 0.01).


CONCLUSIONS
A significant number of men with prostate cancer and LUTS may not derive a good palliative benefit from TURP. Patients with hormone refractory disease in particular are more likely to have poorer outcomes.
Gnanapragasam
Vincent J
VJ
Department of Urology, Freeman Hospital, Newcastle upon Tyne, UK. v.j.gnanapragasm@ncl.ac.uk
Kumar
Vinod
V
Langton
David
D
Pickard
Robert S
RS
Leung
Hing Y
HY
D000368:Aged; D000369:Aged, 80 and over; D006801:Humans; D008297:Male; D008875:Middle Aged; D010166:Palliative Care / Q000379:methods; D011470:Prostatic Hyperplasia / Q000150:complications / Q000628:therapy*; D011471:Prostatic Neoplasms / Q000150:complications / Q000628:therapy*; D012189:Retrospective Studies; D020728:Transurethral Resection of Prostate / Q000009:adverse effects / Q000379:methods; D016896:Treatment Outcome; D014549:Urinary Incontinence / Q000209:etiology