Factors related to receipt of non-cancer-related transurethral prostatectomy: findings from a large prospective study of 106 769 middle-aged and older Australian men.
Transurethral prostatectomy (TURP) is a common surgical intervention for chronic lower urinary tract symptoms (LUTS). Little large-scale evidence exists on factors related to receipt of non-cancer-related TURP.



A prospective study of men aged ≥45 years participating in the 45 and Up Study, a large Australian cohort study, without prior prostatectomy and/or bowel/genital/urinary-tract cancer; questionnaire data were linked to hospitalisations and deaths. HRs for TURP were estimated in relation to multiple factors, adjusting for confounders.



There were 3416 incident TURPs among 106 769 men (median follow-up 5.8 years), with rates of 1.8, 5.3, 9.1 and 11.4/1000 person-years for ages 45-54, 55-64, 65-74 and ≥75 years, respectively. Age-adjusted rates of TURP varied markedly according to baseline LUTS from 2.2/1000 person-years with no/mild symptoms to 30.7/1000 person-years with severe symptoms. Annual household income ≥$70 000 versus <$20 000, having private health insurance and living in major cities were associated with higher TURP rates; there were no significant differences according to baseline diabetes, stroke, high blood pressure or cardiovascular disease. Men reporting severe versus no physical functioning limitation, high versus low psychological distress or poor versus excellent self-rated health were 36-51% more likely to undergo procedures overall, but were 24-37% less likely to undergo procedures following additional adjustment for need (baseline LUTS).



TURP rates were most strongly related to baseline LUTS and age, consistent with appropriate health services targeting. Lower TURP rates in men experiencing socioeconomic disadvantage and with poor health/disability, after accounting for baseline LUTS, suggest inequity and factors such as frailty and risks related to surgery.
National Centre for Epidemiology and Population Health, Research School of Population Health, Australian National University, Canberra, Australian Capital Territory, Australia.
Grace
G
Joshy
National Centre for Epidemiology and Population Health, Research School of Population Health, Australian National University, Canberra, Australian Capital Territory, Australia.
Kay
K
Soga
National Centre for Epidemiology and Population Health, Research School of Population Health, Australian National University, Canberra, Australian Capital Territory, Australia.
Rosemary J
RJ
Korda
Discipline of Surgery, University of Sydney, Sydney, New South Wales, Australia.|Department of Urology, Westmead Hospital, Sydney, New South Wales, Australia.
Manish I
MI
Patel
National Centre for Epidemiology and Population Health, Research School of Population Health, Australian National University, Canberra, Australian Capital Territory, Australia.|The Sax Institute, Sydney, New South Wales, Australia.
Emily
E
Banks
D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease; D006801:Humans; D007182:Income / Q000706:statistics & numerical data; D059411:Lower Urinary Tract Symptoms / Q000503:physiopathology* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009517:New South Wales / Q000453:epidemiology; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D020728:Transurethral Resection of Prostate / Q000706:statistics & numerical data*; D016896:Treatment Outcome
men's health; transurethral prostatectomy