Delayed surgical treatment of benign prostatic hyperplasia: a subjective estimation of change in the operative risk profile

Abstract

Background Benign prostatic hyperplasia (BPH) patients are nowadays operated on at an older age, usually after they have received medical treatment for a long period of time. We correlated physical status classification indices (American Society of Anesthesiologists (ASA) and Goldman's) with the patients’ profiles and estimated, subjectively, the operative risk profile at the time of the first visit to a urologist for BPH-related lower urinary tract symptoms (LUTS). Methods Fifty-six patients aged 51–84 years, scheduled for transurethral or open adenomatectomy, were included in the study. Physical status indices were correlated with patient and disease characteristics, as well as with the time from the first visit seeking advice for BPH-related LUTS to the final decision for surgical treatment. Anesthesiologists estimated whether the operative risk would have been lower if surgery had been offered as a first line treatment option. Results ASA and Goldman's indices did not correlate with patient and disease characteristics except for the correlations of the ASA index with comorbidity and with time from first visit, and Goldman's index with age. Subjects in whom the decision for surgery was delayed for more than 1 year from initial visit had significantly higher International Prostate Symptom Scores (IPSS) at surgery, and they also had a higher ASA index and acute urinary retention rate. In 12 cases (21.4%) anesthesiologists estimated that operative risk would have been less if surgery had been performed at the time of the first visit, with the probability of a hypothetical change in operative risk profile correlating only with the length of time of LUTS and concomitant cardiovascular or chronic obstructive pulmonary disease. Conclusions As the impact of medical treatment for LUTS/BPH will probably further increase over the coming years, patients at risk of developing complications needing surgery should be estimated for a possible future deterioration of their physical status and be advised accordingly.