Present Status of Transurethral Resection of the Prostate for Benign Prostatic Hypertrophy

SUMMARY In order to carefully evaluate the transurethral resection operation, we have on two occasions analyzed our morbidity and mortality in 4000 consecutive cases by means of a data punch system and a computerized study. 3 , 4 In our last series of 2223 resections, 30 deaths occurred giving an overall mortality of 1.3 per cent. The staff mortality was 0.7 per cent and the resident mortality 1.9 per cent. This incidence of death is fairly constant in most of the clinics where a large number of transurethral resections are done and is much lower than any comparable series of open prostatectomies. Myocardial disease in this group of elderly patients is in all series the most important cause of death and emphasizes the need again of careful preoperative evaluation and constant electrocardiographic monitoring during the operation. The causes of death in this series are presented in Table 1. The average incidence of nonfatal complications is contained in Table 2. Hematuria, early and late, and epididymitis are the most frequently seen complications in this group. Careful hemostasis in the operating room and recognition of the type of bleeding is, of course, essential and will reduce this complication to a negligible figure. Late hemorrhaging usually is due to incomplete resection or excessive activity of the patient. Percutaneous vasal interruption continues to decrease the annoying complication of epididymitis. Judicious replacement of blood loss is important in the older group of patients and an accurate measurement of the blood loss can be determined by measuring the hemoglobin in the irrigating wash fluid. Approximately 25 per cent of our patients received blood either preoperatively or during the operation. Azotemia continues to be a significant factor in the incidence of morbidity and mortality in both of our studies. By giving azotemic patients at least two weeks of catheter drainage and good supplementary care, there has been a marked decrease in the mortality and morbidity in this group of patients. Figure 2 compares the problems encountered in the patients with normal renal function preoperatively and those who are azotemic. The azotemic patient had an increase in mortality from 2.5 to 9 times greater than comparable age group patients with normal renal function. Azotemia itself is not the sole cause of increased mortality and morbidity, but does identify an anemic, debilitated, poorly nourished, chronically ill patient who responds poorly to the trauma of surgery and who is more likely to hemorrhage and resists infection inadequately. All of our studies reveal increased morbidity and mortality in the older age groups and this again emphasizes the importance of treating the disease of prostatism when it is diagnosed rather than waiting for the complications of the disease and forcing the patient to be operated on later under poor circumstances. Any amount of residual urine indicates a decompensated bladder, and infection and impaired renal function are far advanced signs of prostatism.