FACTORS AFFECTING CHANGE IN QUALITY-OF-LIFE AFTER PROSTATECTOMY FOR BENIGN PROSTATIC HYPERTROPHY - THE IMPACT OF SURGICAL TECHNIQUES

Purpose: The impact of prostatectomy on quality of life was assessed i n patients with benign prostatic hypertrophy (BPH) who were classified according to the expected benefit from surgical intervention. The rel ative impact of the 2 surgical techniques (open versus closed) on shor t-term quality of life was compared. Materials and Methods: An observa tional study was done on 545 consecutive patients with BPH undergoing prostatectomy at 3 medical centers in Israel between 1991 and 1992. Re peated structured interviews preoperatively, and at 4 and 12 months po stoperatively were performed, including 6 quality of life questionnair es evaluating BPH specific (symptom severity and symptom effect) and g eneric (activity, independence, mental health and health perception) p arameters. In addition, the interviews consisted of socio-demographic data elements. Clinical details regarding severity of prostatic diseas e and co-morbidity were obtained from the medical charts. Results: We found a correlation between postoperative change in symptom effect and in generic quality of life measures (r-0.11 to 0.20, p <0.04). The po stoperative decrease in the mean symptom effect score was 56% and 52% for severe and moderate preoperative levels, respectively. There was n o decrease in the mean symptom effect score for the mild preoperative level(18% of these patients had postoperative deterioration). A second ary operation, and the combination of diabetes mellitus and poor activ ity level were risk factors for lack of improvement in patients with m oderate preoperative symptom effects. We found that the impact of open prostatectomy on quality of life was similar to that of the closed te chnique after adjustment for patient attributes, except for those with an indwelling urinary catheter in whom an open operation was advantag eous. Conclusions: In patients with BPH and mild symptom effects, and in subgroups of patients with moderate symptom effects surgery should not be recommended. Based on short-term measures of quality of life th ere is no justification for a preference between open and closed opera tions.