Medical Effectiveness/Outcomes Research

Transurethral resection of the prostate for benign prostatic hyperplasia declined dramatically but remains safe

Use of transurethral resection of the prostate (TURP) for benign prostatic hyperplasia (BPH, enlarged prostate) peaked during the 1980s but declined between 1991 and 1997 by 50 percent among white men and 40 percent among black men suffering from BPH. Although the use of TURP has declined overall, proportionately more men who now undergo resections are 80 years of age and older (28 percent in 1997 vs. 21 percent in 1984). Outcomes from the surgery continue to be good, with low risk of reoperation or death within 30 days, according to a study by the Patient Outcomes Research Team (PORT) for Prostate Diseases, which is supported by the Agency for Healthcare Research and Quality (HS08397).

Use of TURP began to decline in the United States in 1987, most likely because of increasing availability of less invasive medical and surgical treatments, changes in reimbursement, and greater involvement of patients in the decisionmaking process, notes PORT leader, Michael J. Barry, M.D., of Massachusetts General Hospital. The researchers used hospital claims data for TURP from a 20 percent national sample of Medicare beneficiaries to examine the trends and outcomes of TURP for BPH since 1984. Compared with 1984 to 1990, age-adjusted rates of TURP for BPH during 1991 to 1997 declined by about 50 percent for white men (14.6 to 6.72 per 1,000) and 40 percent for black men (11.8 to 6.58 per 1,000).

The 30-day mortality rate following TURP for BPH was about 0.4 percent for men 65 to 69 years old for both study periods. However, 30-day mortality in men 70 years of age or older undergoing TURP in the 1990s was significantly lower than during the period 1984 to 1990. Since 1987, the 5-year risk for reoperation following TURP for BPH has remained at 5 percent. For TURPs performed in 1997, there was no significant association between a urologist's surgical volume (the annual number of TURPS performed) and a patient's risk of reoperation or 30-day mortality.

More details are in "Transurethral resection of the prostate among Medicare beneficiaries: 1984 to 1997," by John H. Wasson, M.D., Tom Bubolz, Ph.D., Grace Lu-Yao, Ph.D., and others, in the October 2000 Journal of Urology 164, pp. 1212-1215.

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