Who Should have a Prostatectomy? a Survey of the Management of Patients Presenting with Bladder Outflow Obstruction

[Socioclinical and diagnostic characteristics of prostatism in Spain at the end of the 20th century]

RATIONALE

To study sociodemographic characteristics and current diagnostic and therapeutic behaviour with Benign Prostate Hyperplasia (BPH) patients in Spain at the end of the 20th century.

METHODS

Sociodemographic, clinical, therapeutic and quality of life (QoL) data from study ESECI-98, conducted in Spain (1998-1999) in patients with BPH.

RESULTS

Nine hundred and forty nine patients were evaluable, with a mean (+/- SD) age of 65.6 (+/- 7.8) years, with concomitant diseases (40%), pain/discomfort (34%) and anxiety/depression (23%); QoL score (mean +/- SD) was 72.1 +/- 16.1 on a total possible score of 100. BPH diagnosis was based on symptoms (93%), digital rectal examination (93%) and abdomino-pelvic ultrasonography (76%). PSA was mentioned for the diagnosis of BPH in 54% of the patients and 77% were receiving pharmacological treatment (61% alpha-blockers) during less than 6 months (38%) or more than a year (35%).

CONCLUSIONS

In this study the diagnosis of BPH was mainly based on symptoms, digital rectal examination and abdomino-pelvic ultrasonography. It is worth mentioning that PSA for the diagnosis of BPH, was used in a half of the total number of patients. Pharmacological therapy was used in 3 out of every 4 patients. Compared to a previous national study, there is a change on diagnosis and therapy of BPH.

How Long is Your Waiting List? Experience of a Urological Waiting List Initiative

Experience with a urological waiting list initiative is presented, wherein a list of 231 non-urgent cases was cleared over a 5 month period by a single operator. Some patients had waited 10 years for surgery. Following a postal request, the waiting list was validated; 31.2% of patients wished to be removed. The remaining 68.8% desired surgery and consisted of 51 requiring minor surgical procedures and 108 who needed more major surgery mostly for the relief of bladder outflow obstruction. Minor cases received dates for surgery; however, only 68.2% of this group attended despite being given more than one date for admission. Major cases were reviewed in a pre-admission clinic. General and urological condition was assessed, improved where necessary and surgery booked or delayed accordingly. A small number of patients did not attend or only attended to be reassured that surgery was not needed. Following clinical review, 18.5% of this group did not require operation.

The long urological waiting list is a unique situation where patients listed may no longer require surgery. Reviewing these patients not only reduces numbers but also markedly increases percentage attendance for surgery.