Mortality and reoperation after open and transurethral resection of the prostate for benign prostatic hyperplasia

Article Abstract:

Benign prostatic hyperplasia is a noncancerous growth in the prostate, removable by surgery. Diseased tissue can be removed by inserting an instrument through the opening of the penis (transurethral resection), or by external open surgery, which offers more complete prostate removal. These two methods were compared with respect to mortality and reoperation rates. In this multi-country study, patients having the transurethral operation required more subsequent operations and had higher mortality rates over the long term. Larger prostate glands, usually requiring open surgery, were not associated with improved survival rates. The transurethral procedure, usually performed on sicker patients, was thought to be responsible for the higher mortality rate. However, these high rates were present even in the healthiest of patients. Although most surgeons use transurethral resection procedures, this method needs to be reevaluated.

Case studies, Complications and side effects, Prostatectomy

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Geographic variation in expenditures for physicians' services in the United States

Article Abstract:

Hospitalization rates and costs for medical care may vary widely depending on what geographical area you live in. Researchers analyzed data on hospital admission rates and treatment costs for 23 million Medicare patients in 317 US metropolitan areas in 1989. Costs for outpatient care were also examined. Admission rates were twice as high in some areas as in others. Physician payments per admission also varied considerably, as did payments per patient. Metropolitan areas with high admission rates also had high physician payment rates. Areas with high payment rates for hospital care had high payment rates for outpatient care. Physician payment rates were twice as high in the area with the highest rates (Miami, FL) as those in the area with the lowest rates (San Francisco, CA). Proposals for controlling health care costs must incorporate the widespread geographic variability in physician payment rates.

Economic aspects, Medical care, Demographic aspects, Medical fees

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A comparison of transurethral surgery with watchful waiting for moderate symptoms of benign prostatic hyperplasia

Article Abstract:

Surgery may be more effective than watchful waiting for correcting moderate symptoms associated with benign prostatic hyperplasia. A study of 556 men over 54 years of age found that surgery may reduce the rate of treatment failure and more effectively correct problems with urination. Benign prostatic hyperplasia refers to noncancerous enlargement of the prostate gland, causing problems with urination due to compression or obstruction of the urethra. Transurethral resection, the surgical procedure performed to correct benign prostatic hyperplasia, may be more effective for men experiencing moderate symptoms that diminish their perceived quality of life. The procedure was not found to result in incontinence or impotence. Rates of short-term complications and retreatment after surgery were low. Watchful waiting may be acceptable for men who want to delay surgery or who perceive their symptoms as mild.

Evaluation

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